Group of Biomaterials, Department of Polymeric Nanomaterials and Biomaterials, Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain; Alodia Farmacéutica SL, Madrid, Spain.
Group of Biomaterials, Department of Polymeric Nanomaterials and Biomaterials, Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain; Networking Biomedical Research Centre in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
Semin Arthritis Rheum. 2019 Oct;49(2):171-183. doi: 10.1016/j.semarthrit.2019.02.008. Epub 2019 Feb 19.
Osteoarthritis is a chronic, painful and disabling disease which prevalence is increasing in developing countries. Patients with osteoarthritis present a reduced synovial fluid viscoelasticity due to a reduction in concentration and molecular weight of hyaluronic acid. Currently, the main treatment used to restore the compromised rheological properties of synovial fluid is the viscosupplementation by hyaluronic acid injections that can be combined with oral anti-inflammatory drugs for pain relief. Combination of viscosupplements with chemical agents or drugs is emerging as a new strategy to provide a double action of synovial fluid viscoelasticity recovery and the therapeutic effect of the bioactive principle.
In this review, we present the latest research on the combination of viscosupplements with active molecules. We conducted a literature review of articles published in different web search engines and categorized according to the active molecule introduced into the viscosupplement.
Generally, the introduction of anti-inflammatory molecules have shown to improve pain relief although some cytotoxicity has been demonstrated especially for non-steroidal anti-inflammatory drugs. Other molecules such as antioxidant or disease modifying osteoarthritis drugs have been reported to improve viscosupplementation action. Drug delivery systems combined with hyaluronic acid could enhance the activity of the encapsulated molecules and provide better control over the drug release. Finally, biological approaches such as the use of stem cells or platelet-rich plasma seem to be the most promising strategies for cartilage recovery.
Combination therapy of viscosupplements with therapeutic agents, drug delivery systems or regenerative therapies can improve viscosupplementation outcome in terms of pain relief and joint functionality. However, further research is needed in order to reach more conclusive results.
骨关节炎是一种慢性、疼痛和致残性疾病，在发展中国家的发病率正在上升。骨关节炎患者的滑液粘弹性降低，这是由于透明质酸的浓度和分子量降低所致。目前，用于恢复滑液流变学特性的主要治疗方法是通过透明质酸注射进行粘弹性补充，这种方法可以与口服抗炎药联合使用以缓解疼痛。将粘弹性补充剂与化学剂或药物联合使用，正在成为提供滑液粘弹性恢复和生物活性原理治疗效果双重作用的新策略。
在这篇综述中，我们介绍了粘弹性补充剂与活性分子结合的最新研究。我们对不同网络搜索引擎上发表的文章进行了文献综述，并根据引入粘弹性补充剂的活性分子进行了分类。
一般来说，抗炎分子的引入已被证明可以改善疼痛缓解，尽管一些细胞毒性已被证明，特别是对于非甾体抗炎药。其他分子，如抗氧化剂或治疗骨关节炎的药物，已被报道可以改善粘弹性补充作用。与透明质酸结合的药物输送系统可以增强包裹分子的活性，并更好地控制药物释放。最后，生物方法，如使用干细胞或富含血小板的血浆，似乎是软骨恢复最有前途的策略。
粘弹性补充剂与治疗剂、药物输送系统或再生疗法的联合治疗可以在缓解疼痛和改善关节功能方面改善粘弹性补充的效果。然而，需要进一步的研究以得出更具结论性的结果。
