Yu Shirley P, Hunter David J
a Department of Rheumatology , Royal North Shore Hospital , Sydney , Australia.
b Institute of Bone and Joint Research , Kolling Institute, University of Sydney , Sydney , Australia.
Expert Opin Pharmacother. 2016 Oct;17(15):2057-71. doi: 10.1080/14656566.2016.1232396. Epub 2016 Sep 14.
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.
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.
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.
骨关节炎的传统医学疗法本质上主要是姑息性的，旨在控制疼痛和症状。传统的关节内治疗在指南中不被推荐作为一线治疗，但当传统疗法失败时，它们是潜在的替代方法。
重点介绍了骨关节炎当前和未来的关节内药物治疗，包括皮质类固醇、透明质酸盐，以及商业销售的更具争议性的治疗方法，即富含血小板血浆和间充质细胞疗法。关节内疾病修饰性骨关节炎药物是骨关节炎治疗的未来，旨在进行结构修饰并改变疾病进展。本综述讨论了白细胞介素-1β抑制剂、骨形态发生蛋白-7、成纤维细胞生长因子18、缓激肽B2受体拮抗剂、人血清白蛋白和基因疗法。骨关节炎药物开发的进展受到证明疗效能力的限制。需要高质量的试验来证明现有关节内治疗方法的使用合理性，并倡导更新的、有前景的治疗方法。
骨关节炎治疗研究中的挑战从根本上与骨关节炎病理机制的复杂性有关。在治疗选择有限的疾病中，新型药物带来了希望。这些未来的关节内治疗方法是否会提供具有临床意义的益处，仍然未知。
