A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee

Abstract

The purpose of this systematic review is to discuss emerging evidence in the field of viscosupplementation for chronic knee pain secondary to Osteoarthritis (OA). This review focuses on types of viscosupplementation that are clinically available currently, evidence to support their use, contraindications, and adverse events. Recent FindingsOA, also known as degenerative joint disease, is the most common form of arthritis in the United States, affecting 54.4 million, or 22.7% of the adult population. The knee is the most common joint affected in OA, with up to 41% involvement, 30% in the hands, and 19% in the hips. The pathophysiology of OA is complex, with contributing factors including mechanical stress to the joint, as well as many person-specific factors such as genetic susceptibility, ethnicity, nutrition, and sex. Treatment modalities include weight control, exercise, non-steroidal and steroidal anti-inflammatory drugs, opioids, intra-articular platelet-rich plasma, placebo, corticosteroid injection, intra-articular viscosupplementation, and surgery. Viscosupplementation consists of injection of hyaluronic acid (HA) into affected joints, intending to restore the physiologic viscoelasticity in the synovial fluid (SF) in the absence of inflammation. HA has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to break down the joint matrix. The contraindications for HA injection are similar to any other injection therapy, and adverse events are usually mild, local, and transient. Viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality; however, guidelines recommend neither for nor against its use, demonstrating variability in the existing evidence base. Current VS options divide primarily into native vs. cross-linked and low-molecular-weight vs. high-molecular-weight. Current treatment options include Hylan g-f-20

Chondroprotective Effects of 4,5-Dicaffeoylquinic Acid in Osteoarthritis through NF-κB Signaling Inhibition

“…Viability analysis of 4,5-diCQA on chondrocytes was performed using the MTT assay following the Sigma-Aldrich manufacturer's protocol. The chondrocytes were treated with 4,5-diCQA (10,20,40,100, and 200 µM) for 24 h. Post-incubation, the MTT solution (5 mg/mL) was added to each well (100 µL/well), and the cells were incubated for another 2 h at 37 • C. Next, the cell culture medium, including the MTT solution, was removed, DMSO (1 mL/well) was added to each well, and the absorbance was measured at 565 nm.…”

“…These findings indicate that 4,5-diCQA has potential anti-inflammatory effects by suppressing the IL-1βinduced inflammatory response. (10,20,40,100, and 200 μM) for 24 h, and viability was determined by MTT assay. Cells incubated without 4,5-diCQA were used as controls and were considered 100% viable.…”

“…In addition, there are other treatments that suppress inflammation and pain by injecting hyaluronic acid and steroids into the joint cavity, but there is the possibility that pain will worsen, or bacterial infection will occur after administration [8,9]. Recently, platelet-rich plasma therapy, which concentrates plasma isolated from the patient's own blood and injects it into the treatment site, has been spotlighted, and the treatment rate is currently being discussed positively in many review papers [10][11][12]. Therapeutics are evolving innovatively, but there is still no complete cure.…”

Safety of intra-articular platelet rich plasma injections for large joint osteoarthritis: a review article

“…A pattern of safety was found to suggest low frequency of serious adverse events, including infections and allergic reactions; however, it was found that postinjection pain may be more common and even more severe with intraarticular PRP than other injections, though only for a short period. 3,42,43 Preparation of PRPs also varies significantly depending on the type of system being used. In terms of platelet and leukocyte concentration, preparation can vary immensely in single-spin versus double-spin methods.…”

Benefits of Applying Nanotechnologies to Hydrogels in Efficacy Tests in Osteoarthritis Models—A Systematic Review of Preclinical Studies

“…Among all risk factors, sex and gender could play a key role in diagnosis, prognosis, and personalized therapy, although, currently, the treatment is identical for both men and women [ 8 , 9 ]. The treatments for OA are divided into non-pharmacological, pharmacological, and interventional treatments [ 10 ]. During the early stages of the disease, the Osteoarthritis Research Society International (OARSI) guidelines suggest physical activity and weight loss, and pharmacological treatments, based on the administration of oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), are recommended in the more advanced phases to treat pain [ 11 ].…”