Development and Prospect of Intra-Articular Injection in the Treatment of Osteoarthritis: A Review

Figures & data

Table 1 Information About Intra-Articular Injection of Corticosteroids

Agent	Anti-Inflammatory Potency	Action Time	Dose: From Small Joint to Large Joint	Serum Half-Life	Fluorinated
Hydrocortisone acetate	1	S	10–25 (mg)	2h	No
Triamcinolone acetate	5	I	2.5–15 (mg)	88min	Yes
Triamcinolone hexacetonide	5	I	2–20 (mg)	88min	Yes
Methylprednisone acetate	5	I	4–80 (mg)	18–26h	No
Dexamethasone	25	L	0.8–4 (mg)	36–54h	Yes
Betamethasone acetate	25	L	0.25–2 (mL)	6.5h	Yes
Betamethasone sodium phosphate	25	L	0.25–2 (mL)	6.5h	Yes

Abbreviations: S, short = 8–12h biologic half-life; I, intermediate = 12–36h biologic half-life; L, long = 36–72h biologic half-life.

Table 2 Indications, Contraindications and Adverse Reactions of the Intra-Articular Injection of Corticosteroid, and the Methods to Reduce the Incidence of Adverse Reactions

Indications	Contraindications	Adverse Reactions
Osteoarthritis	Intra-articular or osteochondral fracture at the injection site	Injection site pain and local swelling
Rheumatoid arthritis	Uncontrolled coagulopathy	Atrophic changes of skin
Traumatic arthritis	Severe joint destruction (eg, Charcot joint) and skin breakdown	Septic arthritis
Shoulder periarthritis	Local infection: septic arthritis, periarticular sepsis and bacteremia	Chondrotoxicity
Crystalline arthropathies	Hypersensitivity to the injection	Anaphylactic reactions
Seronegative arthropathies	Osteomyelitis	Soft tissue calcinosis
Mixed connective tissue disease	Joint prosthesis	Crystal-induced erythema

Figure 1 The structure formula of hyaluronic acid.

Table 3 Information About Drugs Which Contain Hyaluronic Acid

Product	Dosage	Frequency
Hyalgan	2.0mL	Once a week for 5 weeks
Supartz	2.5mL	Once a week for 5 weeks
Supartz FX	2.5mL	Once a week for 5 weeks
Orthovisc	2.0mL	Once a week for 3 to 4 weeks
Euflexxa	2.0mL	Once a week for 3 to 5 weeks
Hylan G-F 20	2.0mL	Once a week for 3 weeks

Table 4 Western Ontario and McMaster University Osteoarthritis Index (WOMAC) Questionnaire

Pain	Stiffness	Physical Function
Walking	The severity of your stiffness after wakening up in the morning	Descending stairs; Ascending stairs; Rising from sitting;
Up and down the stairs		Standing; Bending to floor; Walking on flat; Getting in/out of car;
During sleep	The severity of of your stiffness after sitting, lying or resting later in the day	Shopping; Putting on socks; Rising from bed; Taking off socks;
Sitting or lying		Lying in bed; Getting in/out the bath; Sitting; Getting on/off toilet;
Standing upright		Heavy domestic duties; Light domestic duties

Figure 2 Visual Analog Scale (VAS), a common tool for measuring pain.

Figure 3 The preparation process of platelet-rich plasma (PRP).

Table 5 A Summary of the Information About MSC Acquired from Several Common Sources

Cell Source	Positive Characterization	Advantages	Disadvantages	Latest Studies Related to OA
Bone marrow	CD105,CD73, CD90, CD271,CD146, low-affinity nerve growth factor receptor (LNGFR)	High chance of differentiating into cartilage Rich in sources	High variability The number and quality of cells decrease with age	Doyle^Citation60 et al (2020)
Adipose tissue	CD73,CD90,CD105	Low donor site morbidity Rich in sources Easy to get	The number and quality of cells decrease with age Low chance of differentiating into cartilage	Woo^Citation61 et al (2020)
Synovial membrane	CD44,CD73,CD90, CD105,CD166, CD271	High chance of differentiating into cartilage Low osteogenic potential	Low numbers	Gale^Citation62 et al (2019)
Placenta	CD90,CD105,CD166, CD49e,SH3,SH4, HLA-ABC	High chance of differentiating into cartilage	Hard to get Low numbers	Khalifeh Soltani^Citation63 et al (2019)
Umbilical cord blood	CD13,CD29,CD49e, CD54,CD90 a-smooth muscle actin	Easy to get Unlimited numbers	High variability	Jeon^Citation64 et al (2020)
Umbilical cord perivascular cells	CD105,CD73,CD90, CD44	Easy to get Unlimited numbers	High variability	Klontzas^Citation65 et al (2015)
Cartilage	CD49e,Notch1, CD90, STRO-1	High chance of differentiating into cartilage	High donor site morbidity Low number	Hu^Citation66 et al (2019)
Fat pad	CD13,CD44,CD90, CD105,CD29	Rich in sources Easy to get	Low chance of differentiating into cartilage	Bravo^Citation67 et al (2018)
Skeletal muscle	NG2,CD146	Easy to get Unlimited numbers.	High variability	Camernik^Citation68 et al (2020)

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