The perspectives of intra-articular therapy in the management of osteoarthritis

ABSTRACT

Introduction

Management of Osteoarthritis (OA) still is a challenge for clinicians. Taking into account a multidisciplinary approach including pharmacological and non-pharmacological treatments, intra-articular (IA) injection could be considered as an effective local therapy.

Areas covered

This review provides a new perspective of IA treatment going beyond current available IA agents. We describe novel biological targets for developing new IA agents and innovative modalities of delivery systems. Additional topics include predictors of response for a better choice of IA agents for each patient, diagnostic and prognostic role of biomarkers, accuracy of IA injection, and cost-effectiveness of IA injection.

Expert opinion

IA treatments seem to be very promising for the management of OA. Identifying clinical and biochemical predictive factors could drive clinician to the appropriate therapeutic approach. To date, there is a gap regarding the benefit of IA treatments in the ‘real practice’ once they have been adopted. However, considering these promising effects of IA approach, several open questions remain not clarified.

KEYWORDS:

• Osteoarthritis
• hyaluronic acid
• corticosteroid injection
• mesenchymal stem cells
• cartilage regeneration
• viscosupplementation
• intra-articular injection

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• Obesity, severe joint space narrowing, severe clinical presentation, and local tenderness seems to be associated with a higher rate of IA injection failure in patients with OA.

• Mesenchymal Stem cells is a promising strategy for OA, but unclear question remains about concentration, dosing regimen and volume and best candidate to the treatment.

• U-type II collagen C telopeptide [78] and Type II Collagen degradation (Coll2-1) seem to be predictive of response to intra-articular hyaluronic acid.

• Nano-formulations could offer new innovative modalities to improve agent vehiculation and maintains therapeutically relevant intraarticular concentrations.

• Ultrasound guidance could improve the accuracy of intra-articular injection in particular for small joints

This box summarizes the key points contained in the article.

Additional information

Funding

This paper was not funded.