Multimodal approach to intraarticular drug delivery in knee osteoarthritis
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Rheumatology INTERNATIONAL
REVIEW
Multimodal approach to intraarticular drug delivery in knee osteoarthritis Tsvetoslav Georgiev1,2 Received: 4 July 2020 / Accepted: 8 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Knee osteoarthritis · Hyaluronic acid · Intraarticular injections · Mesenchymal Stem cells · Small molecules · Gene therapy
Introduction Osteoarthritis (OA) comprises a group of overlapping progressive clinical conditions caused by an interplay of systemic (genetic, hormonal, and metabolic) and local factors (biochemical and biomechanical) which ultimately lead to structural destruction and joint failure [1]. By affecting the whole structure and functions of a single joint and a set of joints, OA poses a management challenge due to the need to target numerous pathologically changed tissues and organ functions at about the same time [2]. Currently, there are no effective non-operative treatment options to initiate
* Tsvetoslav Georgiev [email protected] 1
First Department of Internal Diseases, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria
Clinic of Rheumatology, University Hospital “St. Marina”, 1, Hristo Smirnenski, 9010 Varna, Bulgaria
2
and maintain the joint regeneration and modify the disease course [3]. The alarmingly high incidence of knee OA (KOA) in the globalized world necessitates immediate action plans to combat the pandemic of this disease [4]. The recent advances in our understan
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