Multimodal approach to intraarticular drug delivery in knee osteoarthritis

Abstract

The expectations from any future disease-modifying treatment for knee osteoarthritis (KOA) are extremely high as it has to impact the joint as a whole leading to favorable alterations of diverse tissues and functions. In this light, targeting the knee only from the inside may not be biologically justified for the management of a whole joint disease such as KOA. Our hypothesis to test is whether any injectable therapeutic intervention alone can lead to disease modification of KOA which is viewed in the complexity of the modern concept of osteoarthritis (OA) as a whole joint disease. Therefore, we aimed at analyzing the intraarticular route to the KOA patient in an attempt to unveil its "biological" constraints. A comprehensive search through databases was carried out using specific keywords to add objectivity to the main messages. The literature analysis has shown that "cutting-edge" intraarticular therapies may offer a key to non-invasive symptomatic relief. Changing the course of KOA, however, may necessitate a multimodal approach towards the knee joint including a combination of intraarticular injections with interventions on multiple levels. Importantly, our understanding of OA has evolved redefining the concept of the disease, being in interaction with the human body as a whole. Any future conservative disease-modifying treatment of KOA should aim at a multimodal, holistic approach towards the knee joint including but not limited only to intraarticular injections. A combination with other interventions should be further researched.

Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials

“…According to the SUCRA and GRADE ranked results, the combined treatment IAI+PT not only yielded a greater superiority but stronger evidence than did its monotherapies. In line with the OARSI guidelines for the non-surgical management of KOA [ 139 ], IAI+PT should be recommended as the main option to treat KOA rather than IAI or PT alone, especially for relieving pain and enhancing walking capability [ 140 ].…”

Therapeutic applications of adipose-derived stromal vascular fractions in osteoarthritis

“…Considering that osteoarthritis is a whole joint disease, OA should be treated with combined therapy. Through intraarticular injection therapy, treatment agents can directly reach the damaged site, which can not only allow drugs and especially stem cells to avoid being cleared by the body but also reduce the potential systemic effects of drugs[ 69 ]. Especially for traumatic arthritis, cartilage adipose stem cells provide a new avenue for the treatment of this type of arthritis through their powerful differentiation ability and paracrine and anti-inflammatory effects.…”

Polycystic ovary syndrome metabolic and hormonal dysfunction in relation to osteoarthritis onset and development: innocent bystander or major risk factor?

“…It is characterized by disorders both at the level of joint tissues and cells and in the functional unity of the body [8,9]. Therefore, a multimodal and multilevel therapeutic approach targeting different elements of the joint would be most effective [10], especially when started in the earliest preclinical and pre-radiographic stages of the disease.…”