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A Strategic Approach to Knee Arthritis TreatmentIntra-articular Injection Therapy and Biologic Treatment

A Strategic Approach to Knee Arthritis Treatment: Intra-articular Injection Therapy and Biologic... [Oral or parenteral administered drugs used to treat knee osteoarthritis (OA) enter the joint through complicated pharmacokinetic processes. Intra-articular (IA) injection therapy has a number of advantages over systemic administration such as bypassing this process and avoiding systemic adverse events. For IA injection therapy to work effectively, drugs must be injected accurately into the joints. Image guided injection using ultrasound is more useful than blind method for accurate IA injection. IA therapeutic agents for the treatment of knee OA include corticosteroids (CS), hyaluronic acid (HA), biologics. CS has a short-term effect on improving symptoms of knee OA, but HA has a relatively longer term effect. Biologic agents either target specific catabolic proinflammatory mediators or affect anabolism because OA results from an imbalance between catabolic and anabolic factors. Biologics used for treatment of knee OA are categorized into non-cellular or cell therapy. Non-cellular therapy includes human serum albumin, growth factors, cytokine antagonists. In particular, the recombinant human fibroblast growth factor 18 and the wnt receptor inhibitor have an anabolic effect. Cell therapy includes cell concentrates, mesenchymal stromal cells, and gene therapy. Recently, cell concentrates are commonly used for knee OA treatment as autologous point-of-care cell therapy regardless of its efficacy. Cell concentrates include stromal vascular fraction (SVF), bone marrow aspirate concentrate (BMAC), plasma rich platelet (PRP), and autologous protein solution. The therapeutic effects of PRP remain for more than 6 months, but effect size has not reached minimal clinical important difference. Mesenchymal stromal cells (MSCs) are grown from cell concentrates in vitro and separated with only cells with MSC characteristics. MSCs used in the treatment of knee OA include bone marrow-derived MSCs and adipose-derived MSCs. Despite the clinical potential of MSCs, clinical efficacy in knee OA treatment is limited. According to guidelines from non-profit organizations, PRP and MSC injections are strongly recommended against in patients with knee OA.] http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

A Strategic Approach to Knee Arthritis TreatmentIntra-articular Injection Therapy and Biologic Treatment

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References (180)

Publisher
Springer Singapore
Copyright
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2021
ISBN
978-981-16-4216-6
Pages
171 –212
DOI
10.1007/978-981-16-4217-3_10
Publisher site
See Chapter on Publisher Site

Abstract

[Oral or parenteral administered drugs used to treat knee osteoarthritis (OA) enter the joint through complicated pharmacokinetic processes. Intra-articular (IA) injection therapy has a number of advantages over systemic administration such as bypassing this process and avoiding systemic adverse events. For IA injection therapy to work effectively, drugs must be injected accurately into the joints. Image guided injection using ultrasound is more useful than blind method for accurate IA injection. IA therapeutic agents for the treatment of knee OA include corticosteroids (CS), hyaluronic acid (HA), biologics. CS has a short-term effect on improving symptoms of knee OA, but HA has a relatively longer term effect. Biologic agents either target specific catabolic proinflammatory mediators or affect anabolism because OA results from an imbalance between catabolic and anabolic factors. Biologics used for treatment of knee OA are categorized into non-cellular or cell therapy. Non-cellular therapy includes human serum albumin, growth factors, cytokine antagonists. In particular, the recombinant human fibroblast growth factor 18 and the wnt receptor inhibitor have an anabolic effect. Cell therapy includes cell concentrates, mesenchymal stromal cells, and gene therapy. Recently, cell concentrates are commonly used for knee OA treatment as autologous point-of-care cell therapy regardless of its efficacy. Cell concentrates include stromal vascular fraction (SVF), bone marrow aspirate concentrate (BMAC), plasma rich platelet (PRP), and autologous protein solution. The therapeutic effects of PRP remain for more than 6 months, but effect size has not reached minimal clinical important difference. Mesenchymal stromal cells (MSCs) are grown from cell concentrates in vitro and separated with only cells with MSC characteristics. MSCs used in the treatment of knee OA include bone marrow-derived MSCs and adipose-derived MSCs. Despite the clinical potential of MSCs, clinical efficacy in knee OA treatment is limited. According to guidelines from non-profit organizations, PRP and MSC injections are strongly recommended against in patients with knee OA.]

Published: Oct 13, 2021

Keywords: Intra-articular injection; Pharmacokinetics; Ultrasound; Corticosteroid; Hyaluronic acid; Polydeoxyribonucleotide; Hypertonic dextrose; Biologics; Growth factors; Cytokine antagonists; Plasma rich platelet; Mesenchymal stromal cells

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