Knee osteoarthritis: pathophysiology and current treatment modalities

Abstract

For decades, multiple attempts to fully understand knee osteoarthritis pathophysiology and natural history have been attempted. Despite the extensive amount of research regarding this topic, there are still marked controversies. This multifactorial condition gets influenced by local, systemic, and external factors and its progression and/or response to treatments widely varies from patient to patient. Multiple therapies have been studied in the past, low impact physical activity seems to be supported by all the current medical societies while other interventions have shown conflicting findings. Newer therapies and routes of administration are under investigation and some of them have shown promising preliminary reports. This review intends to give an overview of the current knowledge of pathophysiology and non-surgical therapies available for knee osteoarthritis.

A double‐blind, randomized, placebo‐controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis

“…Osteoarthritis is the most usual form of arthritis and one of the leading causes of disability. OA is a chronic and low‐grade inflammation, involving mainly innate immune mechanisms (Mora, Przkora, & Cruz‐Almeida, ). It is well known that inflammatory mediators associated with OA include cytokines, chemokines, growth factors, adipokines, prostaglandins, leukotrienes, nitric oxide, and neuropeptides (Robinson et al, ).…”

“…Osteoarthritis is the most usual form of arthritis and one of the leading causes of disability. OA is a chronic and low-grade inflammation, involving mainly innate immune mechanisms (Mora, Przkora, & Cruz-Almeida, 2018). It is well known that inflammatory mediators associated with OA include cytokines, chemokines, growth factors, Creatinine (mg/dl) Pretreatment 0.7 ± 0.1 0.7 ± 0.2 0.7 ± 0.1 p = 0.24 95% (CI) 0.7, 0.8 0.6, 0.7 0.6, 0.7 Postreatment 0.7 ± 0.2 0.7 ± 0.2 0.6 ± 0.2 p = 0.03 95% (CI) 0.7, 0.8 0.6, 0.8 0.6, 0.7 p value 0.45 0.67 0.04* adipokines, prostaglandins, leukotrienes, nitric oxide, and neuropeptides (Robinson et al, 2016).…”

“…It is well known that inflammatory mediators associated with OA include cytokines, chemokines, growth factors, Creatinine (mg/dl) Pretreatment 0.7 ± 0.1 0.7 ± 0.2 0.7 ± 0.1 p = 0.24 95% (CI) 0.7, 0.8 0.6, 0.7 0.6, 0.7 Postreatment 0.7 ± 0.2 0.7 ± 0.2 0.6 ± 0.2 p = 0.03 95% (CI) 0.7, 0.8 0.6, 0.8 0.6, 0.7 p value 0.45 0.67 0.04* adipokines, prostaglandins, leukotrienes, nitric oxide, and neuropeptides (Robinson et al, 2016). Historically, cyclooxygenase inhibitors (acetaminophen and NSAIDs) have been the most commonly used medications; however, due to the gastrointestinal, renal, cardiac, and haematological adverse effects of these medications, their long-term use is limited (Mora et al, 2018). Some mild side effects were observed during the treatment period, such as gastrointestinal symptoms (acidity, constipation, and oral ulcers), however, no significant differences were found.…”

Letter to Kajiwara et al. ‘Letter in response to “Impacts of a multicomponent intervention programme on neuropsychiatric symptoms in people with dementia and psychological health of caregivers: a feasibility pilot study”’

“…Concerning the programme design, we agree with Dr Kaijiwar and his colleagues that incorporating knowledge of BPSD in the context of OA into the intervention may be useful and needs further investigation in future study.Self-management and regular exercise are the critical factors in knee OA management. 3,4 Considering outcomes measures of our programme, we measure their in-home exercise adherence by asking the caregivers about the PWD spending how much time on exercise per week. The results showed that the total duration of exercise per week in IG increased statistically significant (P < .022) after the intervention.And this result will be published elsewhere.In addition, in most of our caregiver participants, the full-time domestic helpers were delivering the home exercises.…”

“…Self-management and regular exercise are the critical factors in knee OA management. 3,4 Considering outcomes measures of our programme, we measure their in-home exercise adherence by asking the caregivers about the PWD spending how much time on exercise per week. The results showed that the total duration of exercise per week in IG increased statistically significant (P < .022) after the intervention.…”