First Department of Internal Diseases, Faculty of Medicine, Medical University-Varna, Varna, Bulgaria.
Clinic of Rheumatology, University Hospital "St. Marina", 1, Hristo Smirnenski, 9010, Varna, Bulgaria.
Rheumatol Int. 2020 Nov;40(11):1763-1769. doi: 10.1007/s00296-020-04681-7. Epub 2020 Aug 16.
The expectations from any future disease-modifying treatment for knee osteoarthritis (KOA) are extremely high as it has to impact the joint as a whole leading to favorable alterations of diverse tissues and functions. In this light, targeting the knee only from the inside may not be biologically justified for the management of a whole joint disease such as KOA. Our hypothesis to test is whether any injectable therapeutic intervention alone can lead to disease modification of KOA which is viewed in the complexity of the modern concept of osteoarthritis (OA) as a whole joint disease. Therefore, we aimed at analyzing the intraarticular route to the KOA patient in an attempt to unveil its "biological" constraints. A comprehensive search through databases was carried out using specific keywords to add objectivity to the main messages. The literature analysis has shown that "cutting-edge" intraarticular therapies may offer a key to non-invasive symptomatic relief. Changing the course of KOA, however, may necessitate a multimodal approach towards the knee joint including a combination of intraarticular injections with interventions on multiple levels. Importantly, our understanding of OA has evolved redefining the concept of the disease, being in interaction with the human body as a whole. Any future conservative disease-modifying treatment of KOA should aim at a multimodal, holistic approach towards the knee joint including but not limited only to intraarticular injections. A combination with other interventions should be further researched.
对于膝骨关节炎 (KOA) 的任何未来的疾病修饰治疗，人们的期望都非常高，因为它必须影响整个关节，导致多种组织和功能的有利改变。有鉴于此，仅从内部针对膝关节可能不符合生物学原理，无法对 KOA 等整个关节疾病进行管理。我们的假设是检验任何单独的可注射治疗干预是否可以导致 KOA 的疾病修饰，这在现代骨关节炎 (OA) 概念的复杂性中被视为整个关节疾病。因此，我们旨在通过分析 KOA 患者的关节内途径，试图揭示其“生物学”限制。通过使用特定关键字在数据库中进行了全面搜索，以提高主要信息的客观性。文献分析表明，“尖端”关节内疗法可能为非侵入性症状缓解提供关键。然而，改变 KOA 的病程可能需要对膝关节采取多模式方法，包括将关节内注射与多个层面的干预相结合。重要的是，我们对 OA 的理解已经发展，重新定义了疾病的概念，与人体整体相互作用。任何未来的 KOA 保守疾病修饰治疗都应该针对膝关节的多模式、整体方法，包括但不限于关节内注射。应进一步研究与其他干预措施的结合。
