Department of Rheumatology, Hopital Henri Mondor, 94010 Creteil, France.
Curr Drug Targets. 2010 May;11(5):546-60. doi: 10.2174/138945010791011866.
To date, no targeted treatments for osteoarthritis have been developed. Therefore the challenge for the next years is to find a treatment that may slow down the progression of the disease. Osteoarthritis of the weight-bearing joints, such as knee OA, is more a local mechanical driven disease than a generalized one. To reach a non-vascularised tissue such as the cartilage, local intra-articular administration of drugs should be considered. The purpose of this review is to evaluate the advantages of local intra-articular drug administration compared with a systemic one in patients with osteoarthritis of weight-bearing joints. New perspectives of such strategy are reviewed, including anti-cytokine therapy, gene therapy, delivery of growth factors, stem cells therapy and new lubricant agents such as lubricin. The main goal in the future will be to increase the residence time of the drug in the joint while improving its diffusion within the target tissues. One key question will be how to better define the patients likely to benefit by such an approach and when the treatment is most likely to work. Most importantly, the treatment strategy must be selected according to the pattern in an individual patient. Finally, with all intra-articular treatments, the risk/benefit ratio must be carefully evaluated.
迄今为止，尚未开发出针对骨关节炎的靶向治疗方法。因此，未来几年的挑战是找到一种可能减缓疾病进展的治疗方法。承重关节（如膝骨关节炎）的骨关节炎更多是一种局部机械驱动的疾病，而不是全身性疾病。为了到达软骨等非血管化组织，应考虑局部关节内药物给药。本综述的目的是评估与全身给药相比，局部关节内药物给药在承重关节骨关节炎患者中的优势。综述了这种策略的新观点，包括抗细胞因子治疗、基因治疗、生长因子传递、干细胞治疗和新型润滑剂，如润滑素。未来的主要目标是在提高药物在关节内停留时间的同时，改善其在目标组织内的扩散。一个关键问题是如何更好地定义可能受益于这种方法的患者，以及治疗最有可能起作用的时间。最重要的是，必须根据个体患者的情况选择治疗策略。最后，对于所有关节内治疗，必须仔细评估风险/收益比。
