Thus, the goal of intra-articular HA injection is to restore the viscoelasticity of synovial fluid, and it is a common practice despite controversy in the literature. In knee OA, both the concentration and the molecular weight of intra-articular HA are reduced (concentration is decreased around 50 %), which decreases the viscoelasticity of synovial fluid. Hyaluronic acid (HA) is a standard constituent of normal synovial fluid and an essential component of joint homeostasis providing lubrication and shock absorption to the knee joint.
#Product that helps decrease fluid in knee injury update
This article aims to review the biological update on treating knee OA. However, the current literature assesses new therapies that might change the way OA is treated, including therapies addressing the pathophysiology described earlier. Consequently, nonsteroidal anti-inflammatory drugs (NSAIDs), pain medications, steroid injections, and viscosupplements have become the most common pharmacologic treatment options. OA management has focused on relieving pain and improving functional symptoms. Conservative treatment has led to better clinical outcomes when combined with modalities such as core treatment, biomechanical interventions, medications, intra-articular injections, and others. The treatment of OA has evolved in the past few decades, during which advances in conservative and surgical interventions have been achieved. Furthermore, oxide synthase 2, cyclooxygenase (COX)-2, and prostaglandin E gene expression are increased as well, contributing to articular inflammation and destruction by enhancing the activation and production of MMPs and the inhibition of type II collagen proteoglycan synthesis. During cartilage degradation, fragments of matrix components are released, such as aggrecan, collagen, and fibromodulin fragments, which maintain inflammatory cytokine production. The inflammatory microenvironment supports the rise of proteolytic enzymes, matrix metalloproteinases (MMP-13 and MMP-1), and A disintegrin and metalloproteinase with thrombospondin-1 domains 4 and 5. In addition, these cytokines intensify and maintain OA disease by inducing the production of other proinflammatory cytokines, such as IL-8, IL-15, IL-17, IL-8, IL-21, and leukemia inhibitory factor. These cytokines contribute to OA pathogenesis through several mechanisms contributing to the phenotype shift of chondrocytes, through which activated cells increase the expression of catabolic and proinflammatory genes. The main proinflammatory cytokines involved in the pathophysiology of OA are interleukin (IL)-1β, tumor necrosis factor, and IL-6. Chondrocytes and synovial cells change their quiescent phenotype in response to an abnormal microenvironment from trauma-induced inflammation. OA is a pathology accompanied by an increased presence of inflammatory cytokines and proteolytic molecules in the tissue, which in turn leads to extracellular matrix degeneration and functional impairment. Therefore, OA is treated by a combination of interventions, including lifestyle modification, exercise, and pharmacologic and biomechanical treatments. Despite the high prevalence of OA, however, there are no specific guidelines approved by the US Food and Drug Administration for slowing structural joint deterioration. It is well recognized that the world population is becoming progressively older and the incidence and prevalence are increasing, a fact that contributes to a global problem. Īlthough the prevalence is alarming, the real burden of OA has been underestimated. As aging, obesity, and sports-related trauma are increasing and the pathoetiology of OA is multifactorial, the result from a combination of the above factors might contribute to the high prevalence of OA. Risk factors for OA include advancing age, obesity, being a postmenopausal woman, previous trauma, malalignment, and genetic factors. The overall prevalence of OA in symptomatic elderly patients is around 12.1 %. In 2005, approximately 27 million Americans were affected by OA.
Many people over the age of 65 years demonstrate clinical and radiographic evidence of OA, making this illness the most common disorder of the musculoskeletal system, affecting both small and large joints. Osteoarthritis (OA) is a progressive disease resulting in functional impairment.
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