Intra-articular therapies for osteoarthritis

ABSTRACT

Introduction: Conventional medical therapies for osteoarthritis are mainly palliative in nature, aiming to control pain and symptoms. Traditional intra-articular therapies are not recommended in guidelines as first line therapy, but are potential alternatives, when conventional therapies have failed.

Areas covered: Current and future intra-articular drug therapies for osteoarthritis are highlighted, including corticosteroids, hyaluronate, and more controversial treatments marketed commercially, namely platelet rich plasma and mesenchymal cell therapy. Intraarticular disease modifying osteoarthritis drugs are the future of osteoarthritis treatments, aiming at structural modification and altering the disease progression. Interleukin-1β inhibitor, bone morphogenic protein-7, fibroblast growth factor 18, bradykinin B₂ receptor antagonist, human serum albumin, and gene therapy are discussed in this review. The evolution of drug development in osteoarthritis is limited by the ability to demonstrate effect. High quality trials are required to justify the use of existing intra-articular therapies and to advocate for newer, promising therapies.

Expert opinion: Challenges in osteoarthritis therapy research are fundamentally related to the complexity of the pathological mechanisms of osteoarthritis. Novel drugs offer hope in a disease with limited medical therapy options. Whether these future intra-articular therapies will provide clinically meaningful benefits, remains unknown.

KEYWORDS:

• Osteoarthritis
• intra-articular
• corticosteroid
• hyaluronate
• platelet rich plasma
• mesenchymal stem cell

Article highlights

• Intra-articular corticosteroid injections are effective as short term therapies

• Viscosupplementation has small positive effect size with no clinically meaningful benefit over saline.

• Platelet rich plasma and mesenchymal stem cells are potentially attractive treatment options, but more vigorous research and study protocols are required before their use can be advocated.

• Medications targeting structural and pain modification are under trial, such as interleukin 1β inhibitor, bone morphogenetic protein-7, fibroblast growth factor 18, bradykinin B₂ receptor antagonist, human serum albumin and gene therapy.

• Clinical trial designs of intra-articular therapies require more rigorous control and planning to allow for demonstration of clinically meaningful outcomes.

This box summarizes key points contained in the article.

Declaration of interest

D.J. Hunter is supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship. He is a consultant for to Flexion, Nestle and Merck Serono. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper is not funded