Effectiveness of intra-articular therapies in osteoarthritis: a literature review

Abstract

Osteoarthritis is a painful, chronic disease with widespread burden on patients, communities, health and social care systems. Conservative therapies, such as nonpharmacological interventions, systemic drug treatment and intra-articular therapies are used before resorting to surgery; nonetheless, disease control often remains inadequate. Recent advances in osteoarthritis management have aimed to provide greater variety of treatment options. Here, we summarize a targeted literature review evaluating efficacy and safety of intra-articular therapies for osteoarthritis. Injections of intra-articular therapies directly into the joint avoid conventional barriers to joint entry, increase bioavailability and lower systemic toxicity. Intra-articular corticosteroids and hyaluronic acid are established United States Food and Drug Administration (US FDA)/European Medicines Agency (EMA)-approved treatments; however, concerns exist regarding effect duration, safety, effectiveness across populations and heterogeneity. Newer therapies, such as autologous blood products and mesenchymal stem cells, are in development. Benefits of autologous blood products (e.g. platelet-rich plasma, autologous conditioned serum) include an expected improved safety profile and direct targeting of osteoarthritis-related pathophysiology. Autologous conditioned serum is cell-free and manufactured by a standardized process, whereas platelet-rich plasma composition and characteristics can vary. Currently, only limited efficacy comparisons between these biological treatments can be drawn; long-term clinical and safety studies are needed to increase the efficacy evidence base and earn consideration in treatment frameworks.

Short‐Term Therapeutic Effects of Ozone in the Management of Pain in Knee Osteoarthritis: A Meta‐Analysis

“…Ozone IA seems to have a therapeutic effect similar to the IA application of corticosteroids in terms of duration. In patients with knee OA, it has been observed that corticosteroids decrease pain in the short term (1 month); however, some disadvantages are mentioned, such as the probable adverse effect on articular cartilage due to repeated exposure to corticosteroids . Although ozone therapy in addition to its antiinflammatory effects, could provide other benefits such as tissue oxygenation, increased antioxidant effects, cell metabolism activation, and stimulation of angiogenesis, effects that are not achieved with the application of corticosteroid IA.…”

Examination of the Role of Platelet-Rich Plasma in Meniscal Tears

“…11(p1006) The mechanism of action of PRP can be linked to its release of numerous growth factors that encourage bone and tissue healing via activation of various signaling pathways. 6 PRP injections are considered a newer and more unconventional method of treatment. Currently, they remain investigational, and the United States Food and Drug Administration has yet to regulate PRP.…”

“…9 Moreover, PRP cannot be stored or frozen and must be drawn immediately before each injection, which can lead to greater variability in PRP injection composition. 6 There remain inherent risks associated with intra-articular injections, including infection (approximately 1 in 3,000 injections). 12 There is also a 2% to 25% possibility of a postinjection flare or local inflammatory response that can last 2 to 3 days and range from mild to severe.…”

“…They can be safer because they are minimally invasive compared with surgical intervention, can be performed in the office, and have increased bioavailability compared with systemic treatment, allowing for lower doses. 6 Corticosteroids, hyaluronic acid, and platelet-rich plasma (PRP) are more common components of intra-articular injections. Used since the 1950s in other disciplines, such as dermatology and maxillofacial conditions, the use of biologic agents, such as PRP, in health care has increased over time.…”

Intra articular hyaluronic acid versus intra articular triamcinolone hexacetonide in primary osteoarthritis of knee: a comparative study

“…2 The rapid increase in the prevalence of this already common disease suggests that OA will have a growing impact on health care and public health systems in future. 3 Viscosupplementation is a novel safe and possibly effective form of local treatment for osteoarthritis. 4 It aims at supplying replacement hyaluronic acid into the joint space to return the elasticity and viscosity of synovial fluid to normal.…”