Glinkowski Wojciech, Śladowski Dariusz, Tomaszewski Wiesław
Center of Excellence "TeleOrto" for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
Stichting Med Partners, 1098 XH Amsterdam, The Netherlands.
J Clin Med. 2025 Apr 8;14(8):2547. doi: 10.3390/jcm14082547.
: Osteoarthritis (OA) is a degenerative joint disease characterized by progressive cartilage breakdown, synovial inflammation, and pain, which leads to significant disability. IAHA is widely used because of its viscoelastic properties, which restore synovial fluid homeostasis and reduce symptoms. However, emerging evidence suggests that IAHA exerts additional biological effects including chondroprotection, inflammatory modulation, oxidative stress reduction, and pain modulation, which may influence disease progression. : This narrative review examines the biological mechanisms underlying IAHA's role in OA management. The review explored IAHA's effects on synovial fluid viscoelasticity, inflammatory cytokine modulation, cartilage preservation, oxidative stress regulation, and pain pathways, emphasizing the influence of molecular weight variations on therapeutic efficacy. Additionally, this review evaluates IAHA's integration into multimodal treatment strategies, its potential disease-modifying effects, and future directions for personalized treatment approaches. : A comprehensive literature review was conducted using PubMed, Cochrane Library, EMBASE, Scopus, and Web of Science for studies published between January 2000 and March 2024. The search focused on IAHA's molecular, cellular, and biochemical effects in OA and clinical findings assessing its impact on joint function, pain relief, and disease progression. : IAHA improves synovial fluid lubrication, reduces proinflammatory cytokines (IL-1β, TNF-α), inhibits matrix metalloproteinases (MMPs), scavenges reactive oxygen species (ROS), and modulates nociceptive pathways. High-molecular-weight IAHA demonstrates superior efficacy in advanced OA, while low-molecular-weight formulations may be better suited for early-stage disease. Although IAHA's symptom relief is comparable to corticosteroids and NSAIDs, its favorable safety profile and emerging disease-modifying potential support its long-term use in OA management. : IAHA represents a multifaceted therapeutic approach bridging symptomatic relief and regenerative strategies. While long-term efficacy, optimal administration protocols, and patient-specific responses remain subjects of ongoing research, refining treatment selection criteria, dosing regimens, and combination strategies may enhance clinical outcomes. Future studies should explore biomarker-driven approaches, standardize treatment protocols, and assess IAHA's synergy with regenerative medicine to optimize its role in OA management.
骨关节炎（OA）是一种退行性关节疾病，其特征为软骨进行性破坏、滑膜炎症和疼痛，可导致严重残疾。透明质酸关节内注射（IAHA）因其粘弹性特性而被广泛应用，该特性可恢复滑液稳态并减轻症状。然而，新出现的证据表明，IAHA具有额外的生物学效应，包括软骨保护、炎症调节、氧化应激降低和疼痛调节，这可能会影响疾病进展。：本叙述性综述探讨了IAHA在OA管理中作用的生物学机制。该综述探讨了IAHA对滑液粘弹性、炎症细胞因子调节、软骨保存、氧化应激调节和疼痛通路的影响，强调了分子量变化对治疗效果的影响。此外，本综述评估了IAHA融入多模式治疗策略的情况、其潜在的疾病修饰作用以及个性化治疗方法的未来方向。：使用PubMed、Cochrane图书馆、EMBASE、Scopus和Web of Science对2000年1月至2024年3月期间发表的研究进行了全面的文献综述。搜索重点是IAHA在OA中的分子、细胞和生化效应，以及评估其对关节功能、疼痛缓解和疾病进展影响的临床研究结果。：IAHA可改善滑液润滑、减少促炎细胞因子（IL-1β、TNF-α）、抑制基质金属蛋白酶（MMPs）、清除活性氧（ROS）并调节伤害性通路。高分子量IAHA在晚期OA中显示出卓越的疗效，而低分子量制剂可能更适合早期疾病。尽管IAHA的症状缓解效果与皮质类固醇和非甾体抗炎药相当，但其良好的安全性和新出现的疾病修饰潜力支持其在OA管理中的长期使用。：IAHA代表了一种多方面的治疗方法，将症状缓解和再生策略联系起来。虽然长期疗效、最佳给药方案和患者特异性反应仍是正在进行的研究课题，但完善治疗选择标准、给药方案和联合策略可能会改善临床结果。未来的研究应探索生物标志物驱动的方法、规范治疗方案，并评估IAHA与再生医学的协同作用，以优化其在OA管理中的作用。
