Intra-articular therapies for osteoarthritis.
BACKGROUND
Conventional medical therapies for osteoarthritis are mainly palliative in nature, aiming to control pain and symptoms. Traditional intra-articular therapies are not recommended in guidelines as first line therapy, but are potential alternatives, when conventional therapies have failed.


METHODS
Current and future intra-articular drug therapies for osteoarthritis are highlighted, including corticosteroids, hyaluronate, and more controversial treatments marketed commercially, namely platelet rich plasma and mesenchymal cell therapy. Intraarticular disease modifying osteoarthritis drugs are the future of osteoarthritis treatments, aiming at structural modification and altering the disease progression. Interleukin-1β inhibitor, bone morphogenic protein-7, fibroblast growth factor 18, bradykinin B2 receptor antagonist, human serum albumin, and gene therapy are discussed in this review. The evolution of drug development in osteoarthritis is limited by the ability to demonstrate effect. High quality trials are required to justify the use of existing intra-articular therapies and to advocate for newer, promising therapies.


CONCLUSIONS
Challenges in osteoarthritis therapy research are fundamentally related to the complexity of the pathological mechanisms of osteoarthritis. Novel drugs offer hope in a disease with limited medical therapy options. Whether these future intra-articular therapies will provide clinically meaningful benefits, remains unknown.
a Department of Rheumatology , Royal North Shore Hospital , Sydney , Australia.
Shirley P
SP
Yu
b Institute of Bone and Joint Research , Kolling Institute, University of Sydney , Sydney , Australia.
David J
DJ
Hunter
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D007270:Injections, Intra-Articular; D010003:Osteoarthritis / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy
D000305:Adrenal Cortex Hormones
Osteoarthritis; corticosteroid; hyaluronate; intra-articular; mesenchymal stem cell; platelet rich plasma