Carbamazepine in osteoarthritis treatment:A novel approach targeting Nav1.7 channels

Osteoarthritis(OA)presents a growing health concern,with substantial societal and healthcare burdens.Current management focuses on symptom relief,lacking disease-modifying options.Emerging research suggests the sodium channel Nav1.7 as a pivotal target in OA treatment.Preclinical studies demonstrate carbamazepine's efficacy in Nav1.7 blockade,offering significant joint protection in animal models.However,human trials are needed to validate these findings.Carbamazepine's repurposing holds promise for OA management,potentially revolutionizing treatment paradigms.Further research is essential to bridge the gap between preclinical evidence and clinical application,offering hope for improved OA management and enhanced patient quality of life.

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III

BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

Conservative treatment of knee osteoarthritis:A review of the literature

Knee osteoarthritis(KOA)is a common chronic debilitating disease with an estimated prevalence of 23.9%in the general adult population.The condition is characterised by joint pain,functional impairment and significant reduction in quality of life.Management for KOA can generally be divided into conservative(non-operative)and surgical(operative)measures.Conservative management broadly compromises pharmacological and non-pharmacological options and is conventionally the first line treatment to avoid or delay the need for surgical management.The aim of this study is to provide an overview of the current recommendations,efficacy and safety profile of different conservative treatments through a review of the literature.

Stem cell application for osteoarthritis in the knee joint: A minireview

Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Synovial Neuronal Changes in Knee Joint Osteoarthritis

Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced KSS and increased inflammatory score in synovial membrane of medial knee compartment. A significant increase in GAP-43 [P = 0.001], SP [P = 0.05], CGRP [P = 0.05] and TH [P = 0.05] expression was observed and SP, CGRP and NPY were found to be co-existed predominantly with GAP-43 in synovial membrane collected from medial compared to the lateral knee compartment. Conclusions: Regenerating nerve fibers containing sensory and autonomic neuropeptides are associated with pain and inflammation in knee joint OA.

Treatment of condylar osteophyte in temporomandibular joint osteoarthritis with muscle balance occlusal splint and long-term follow-up:A case report

BACKGROUND Condylar osteophytes,a remodeling form of temporomandibular joint osteoarthritis(TMJ OA),mainly manifest as marginal angular outgrowths of the condyle.Previous researchers have advocated surgical removal of condylar osteophytes.Reports on the effect of occlusal splint on TMJ OA patients’joints have mostly focused on treatment with this splint,which can reduce the absorption of the affected condyle and promote repair and regeneration.However,the effect of the splint on the dissolution of condylar osteophytes has not yet been reported.CASE SUMMARY A 68-year-old female patient suffered from occlusal discomfort with left facial pain for 2 years.Cone beam computed tomography showed a rare osteophyte on top of her left condyle.She was finally diagnosed with TMJ OA.The patient refused surgical treatment and received conservative treatment with a muscle balance occlusal splint.The pain experienced by the patient on the left side of her face was relieved,and her chewing ability recovered after treatment.The osteophyte dissolved,and the condylar cortex remained stable during long-term follow-up observations.CONCLUSION The muscle balance occlusal splint could be a noninvasive means of treating condylar osteophytes in TMJ OA patients.

Progress in Traditional Chinese and Weste rn Medicine Treatments and Nursing Care of Knee Osteoarthritis

This paper reviews the causes of knee osteoarthritis, traditional Chinese and Western medicine therapies and nursing research progress and indicates that traditional Chinese and Western medicine have gradually recognized the cause of knee osteoarthritis. Knee osteoarthritis has been treated with various treatments and nursing care planning, and the combination of traditional Chinese and Western medicine has constantly been improved. Nurses should instruct the discharged patient to correctly treat their disease, adopt the health education, and, via the establishment of a healthy lifestyle, insist on a functional exercise to relieve the pain, delay disease progression, and improve quality of life.

Progress of improvement of pain and joint function of knee osteoarthritis treated with thunder-fire moxibustion in the last five years

Objective:To summarize the clinical research of improvement of pain and joint function of knee osteoarthritis treated with thunder-fire moxibustion in the last five years,in order to provide more objective and scientific theoretical basis for the clinical use of thunderfire moxibustion in the treatment of knee osteoarthritis.Methods:By using"thunder-fire moxibustion"and"knee osteoarthritis"as keywords,the clinical literature on the treatment of knee osteoarthritis mainly by thunder-fire moxibustion in the past 5 years in PubMed,CNKI,WF and VIP were analyzed.Results:Thunderfire moxibustion and its compound therapy,including internal use of traditional Chinese medicine,external use of traditional Chinese medicine,drug injection,physical therapy,acupuncture,heat sensitive moxibustion,pricking collaterals,acupoint application and ozone,could relieve pain,improve joint function,improve joint activity,improve patients daily life ability and have less adverse reactions.Conclusion:Thunder-fire moxibustion was a safe,non-invasive and effective treatment for knee osteoarthritis.However,further research is necessary due to the non-rigidity of the current clinical trial design.

Application of Stone Needle Therapy Based on Blood Stasis Theory in the Treatment of 36 Cases of Knee Osteoarthritis in Early and Middle Stage

Objective:To evaluate the clinical efficacy of stone needle therapy based on blood stasis theory for different traditional Chinese medicine(TCM)syndrome types of patients with knee osteoarthritis in early and middle stage.Methods:Totally 36 patients with knee osteoarthritis were enrolled in the orthopaedic ward between March 2016 and December 2017,and diagnosed as qi stagnation and blood stasis syndrome,cold dampness and stasis syndrome,or phlegm and stasis syndrome according to TCM syndrome differentiation.After treatment,stone needle was used for ironing on the different meridian acupoints according to different syndrome.The efficacy of patients with the above three syndromes was respectively evaluated,and the visual analogue scale(VAS)score and western ontario and mcMaster universities arthritis Index(WOMAC)score of the three groups were calculated before treatment,2 weeks,and 4 weeks after treatment.Results:The effective rates of the three groups were 86.67%,81.82%,and 80.00%,respectively.After 2 weeks and 4 weeks of treatment,the VAS and WOMAC scores of the three groups decreased significantly compared to treatment before(P<0.05).Conclusion:Stone needle therapy for ironing on the acupoints around the knee joint has a good therapeutic effect on knee osteoarthritis of different syndrome types,which is worthy of further application.

Expression changes and clinical significance of TLR-4 and IL-1β in serum and knee joint fluid of patients with knee osteoarthritis

Objective:To investigate the expression changes and clinical significance of Toll-like receptor-4(TLR-4)and interleukin-1β(IL-1β)in the serum and knee joint fluid in patients with knee osteoarthritis(KOA).Methods:From June 2017 to December 2018,220 cases of patients with KOA who were admitted in Department of Orthopedics of the Third Affiliated Hospital of Inner Mongolia Medical University(“our hospital”for short)were selected as the observation group.According to the severity of KOA,they were divided into the mild subgroup(n=98),the moderate subgroup(n=80)and the severe subgroup(n=42).In addition,60 cases of volunteers who received the physical examination in Health Medical Center of our hospital were selected as the control group.The levels of TLR-4 and IL-1βin the serum and knee joint fluid were detected by enzyme-linked immunosorbent assay,in order to analyze the correlation of TLR-4 and IL-1βlevels with the severity of KOA.Results:The levels of TLR-4 and IL-1βin the serum and knee joint fluid of the observation group were significantly higher than those of the control group,and the differences were statistically significant(all p<.05).The levels of TLR-4 and IL-1βin the serum and knee joint fluid of the severe subgroup were significantly higher than those of the mild subgroup and the moderate subgroup,and the levels of TLR-4 and IL-1βin the serum and knee joint fluid of the moderate subgroup were higher than those of the mild group.The differences were statistically significant(all p<.05).The levels of TLR-4 and IL-1βin the serum and knee joint fluid were positively correlated to the severity of KOA(r=.706,.729,.741,.715,all p<.05);in the serum,the level of TLR-4 was positively correlated to the level of IL-1β(r=.720,p<.05);in the joint fluid,the level of TLR-4 was positively correlated to the level of IL-1β(r=.736,p<.05).Conclusions:The levels of TLR-4 and IL-1βin the serum and knee joint fluid of KOA patients are abnormally increased,which is closely related with the severity of KOA.It can be used for clinical prediction,diagnosis and treatment of KOA.

Some Problems of Warm Acupuncture in the Treatment of Knee Osteoarthritis

Knee osteoarthritis(KOA)is a chronic derivative joint issue that mainly damages the artistic cartilage and leads to pain,swelling,and stiffness around the joint,which is commomly worldwide.With the aging of society and the increment in obesity rate,the incidence of KOA increases sharply,which seriously effects the quality of human life.Before,how to take effective treatment methods is very important.Severe ways to treat the disease include non-steroidal drugs,local injections,surgery,and cell and gene therapies.However,each therapy has certain defections,such as gastrotestinal tract irritation,cardiovascular safety,or high medical costs for patients.Traditional Chinese medicine has a long history in treating KOA,reported by acupuncture,massage,internal administration of traditional Chinese medicine,and external use of traditional Chinese medicine.In clinical practice,patients can be treated from the root agreement to different etiology,and patients can be treated agreement to different syndrome types by syndrome difference to achieve effect.Studies have shown that warm acupuncture is effect in treating KOA.It has two kinds of treatment methods:acupuncture and moxibustion at the same time.It has fewer side effects and is more acceptable to patients.However,there are still some problems in the basic research and clinical application of warm acupuncture and moxibustion in treating KOA.This paper discussed the existing problems from the followingfive aspects:lack of unified synthesis difference and treatment system,problems in clinical research,weak basic research,problems in the study of moxibustion,and lack of the best treatment program recognized by the academic community.Meanwhile,the selection of acupoints,the relationship between acupuncture depth and anatomy should be further studied in order to offer research ideas for the healthy development of the treatment of KOA with warming acupuncture and moxibustion in the future.

Effect of Osteoarthritis Patients' Gender on Rehabilitation after Total Knee Arthroplasty

Objective To investigate the influence of gender on osteoarthritic knee rehabilitation outcome of osteoarthritis patient undergoing total knee arthroplasty(TKA).Methods We prospectively studied thirty male and thirty female knee primary osteoarthritis patients receiving unilateral TKA with posterior stable-fixed plateau prosthesis at our hospital from March 2003 to March 2008.The age and body mass index of male and female patients were matched.The surgical and rehabilitation clinical factors were compared between two groups.Results There was no significant difference in postoperative hospitalization time,surgical tourniquet time,and wound drainage volume between two groups(P>0.05).The extension/flexion degrees of knee joint before operation,1-week,2-week and 1-year after operation for male patients were 6.0 ± 3.3 degrees/ 114.0 ± 10.0 degrees,2.0 ± 1.6 degrees/93.0 ± 7.4 degrees,0.6 ± 0.6 degrees/104.0 ± 9.9 degrees and 0.3 ± 0.5 degrees/125.0 ± 8.8 degrees,for female patients were 7.0 ± 3.4 degrees/112.0 ± 14.0 degrees,2.0 ± 1.3 degrees/89.0 ± 10.9 degrees,0.9 ± 0.8 degrees/101.0 ± 11.8 degrees,0.4 ± 0.5 degrees/124.0 ± 7.1 degrees.The range of motion before operation,1-week,2-week,and 1-year after operation for male patients was 108.0 ± 9.5 degrees,91.0 ± 7.1 degrees,103.0 ± 9.9 degrees,and 125.0 ± 8.9 degrees,for female patients was 105.0 ± 14.1 degrees,87.0 ± 11.4 degrees,100.0±11.9 degrees,and 124.0 ± 7.0 degrees.The preoperative and 1-year postoperative HSS scores were 55.8 ± 13.3 and 89.6 ± 6.7 for males and 54.5 ± 13.8 and 89.2 ± 4.1 for females.No significant statistical difference was observed between two gender groups in regards to degree of extension and flexion,range of motion and HSS score(P>0.05).Conclusions Gender does not influence postoperative knee function of osteoarthritis patients.TKA significantly improves knee joint function and relieve osteoarthritis-related pain.

Loose Body in the Knee Joint: A Case Report

Background: Loose bodies (LBs) within the knee joint are commonly encountered during clinical practice and are frequently observed during knee arthroscopy. The primary treatment involves the removal of loose bodies;however, their complete eradication is often challenging and may not address underlying diseases, leading to persistent symptoms and the risk of new loose body formation. Aim: This case report aims to present the findings and surgical management of a 52-year-old male with an unusually large osseous loose body in the knee joint and associated pathologies. Case Presentation: The patient, a 52-year-old male, experienced recurrent episodes of severe, sudden, and painful locking of the knee joint, leading to difficulties moving. A plain MRI study was conducted to evaluate the condition of the knee joint, which revealed various degenerative changes and the presence of a loose body. Subsequently, an arthroscopic examination was performed under general anesthesia, uncovering the presence of an abnormally large loose body, as well as other pathologies including chondropathy, meniscal degeneration, and Baker’s cyst. Conclusion: Loose bodies (LBs) in the knee joint pose significant challenges and may lead to debilitating symptoms. Timely diagnosis and appropriate surgical intervention are crucial for symptom relief and the prevention of further joint damage as arthroscopic excision. Comprehensive imaging has a vital role in guiding treatment decisions and optimizing patient outcomes. In this case, the removal of the loose body improved patient outcomes and helped prevent potential joint complications.

Hip Joint Osteoarthritis Pain Sources and Control

Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.

Therapeutic Effect of Chinese Massage Combined with Warm Acupuncture on Knee Osteoarthritis

Objective:To investigate the effect of Chinese massage combined with warm acupuncture on knee osteoarthritis.Methods:60 patients with knee osteoarthritis who were treated in our hospital from January 2017 to October 2019 were selected as the research subjects,and they were randomly divided into 2 groups of 30 patients each.The control group was treated with oral western medicine,and the observation group was treated with massage combined with warm acupuncture.The clinical efficacy and WOMAC index were compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group,and the WOMAC score was lower than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Chinese massage combined with warm acupuncture is effective in treating knee osteoarthritis It can effectively alleviate the symptoms of pain and joint stiffness in patients,and improve joint mobility,which is worth for clinical promotion.

Clinical effect of Rehabmtation Treating combined with Intra-Articular Injection of Sodium Hyaluronate for Exercise induced knee osteoarthritis

Objective: To study the clinical effect of rehabmtation treating combined with intra-articular injection of sodium hyaluronate for exercise induced knee osteoarthritis, and to research the function, biomechanics of knee joint, and inflammatory factor in articular cavity. Method:Selecting 120 patients with exercise induced knee osteoarthritis, then they were randomly divided into control group (n=60) and intervene group (n=60). The patients in the control group were given conventional rehabmtation treating, and the intervene group were given intra-articular injection of sodium hyaluronate on this basic, they were treated 4 weeks. Evaluating the function of knee joint;conduct isokinetic muscle strength test (determination of the angIllar velocity were 60°/S, 180°/S);test the ratio of muscle peak torque and four muscles centripetal centripetal peak torque and peak torque, work load of femoral knee joints after (simultaneous determination of the angular velocity were 60°/S);detect the inflammatory factor in the joint fluid. Results: After the treatment, clinical effect in intervene group was superior to that in control group,but had no statistical significance;after the treatment, the score of function of knee joint in the two groups were higher than before treatment, and had statistical significance, and the score of function of knee joint in the intervene group were higher than control group, and the difference had statistical significance;Angular velocity of 60°/S and 180°/S the two groups peak torque, work load and the H/Q values were significantly increased, the intervene group were higher than control group, and the difference had statistical significance;inflammatory factor in the two groups were significantly decreased, the intervene group were lower than control group, and the difference had statistical significance.Conclusions: On the basic of rehabmtation treating, the treatment of intra-articular injection of sodium hyaluronate can improve the function of knee joint through improving the knee muscle strength, the level of their participation in the activities of the biomechanics of knee joint, and the inflammatory factor in the joint fluid.

Clinical Effective Evaluation of Tongren Dahuoluo Pill (同仁大活络丸) on Knee Osteoarthritis by Musculoskeletal Ultrasound

Objective:To evaluate the clinical effect of Tongren Dahuoluo Pill(同仁大活络丸)on knee osteoarthritis by musculoskeletal ultrasonography.Methods:From March 2019 to December 2019,45 patients with knee osteoarthritis were collected from the outpatient department of the First Medical Center of PLA General Hospital.Tongren Dahuoluo Pill(同仁大活络丸)was given oral treatment for 12 weeks.VAS score,Lequesne score and WOMAC score were recorded before and after treatment,and the changes of knee joint effusion and synovial hyperplasia were observed by musculoskeletal ultrasonography.Results:Among the 45 patients,18 were male and 27 were female,with the average age of(62.07±9.08)years old,and average disease course of(6.83±7.01)years.The VAS score,Lequesne score and WOMAC score were significantly reduced compared with before treatment,and the difference was statistically significant(P<0.01).We observed that joint effusion range and joint synovial hyperplasia thickness of knee osteoarthritis significantly reduced with Tongren Dahuoluo Pill(同仁大活络丸)treatment by musculoskeletal ultrasonography,and the difference were statistically significant(P<0.01).Conclusion:Tongren Dahuoluo Pill(同仁大活络丸)can not only relieve the clinical symptoms of knee osteoarthritis,but also effectively inhibit synovitis hyperplasia of knee joint.

Penetration of Topical Glucosamine Sulfate into the Synovial Fluid of Patients with Knee Osteoarthritis: A Nonrandomized, Open-Label, Single Dose, Bioavailability Study

Objective: This study aims to show that a proprietary topical cream can deliver glucosamine through the skin into the synovial fluid of osteoarthritic patients. This cream contains 10% w/w glucosamine sulfate. It also aims to determine the endogenous level of glucosamine in the synovial fluid of these patients. Therapeutic effectiveness of glucosamine is not addressed in this study. Design: This phase IV, open-label, nonrandomized study enrolled 240 patients. Participants from the Test group received a single dose treatment (2 g of cream), and synovial fluid samples were collected 1 - 3 hours post-treatment. Patients from the Control group were not subjected to any treatment but their synovial fluid was also sampled to establish a glucosamine concentration baseline for Time-0 (T0). Glucosamine concentrations were determined by HPLC analysis. Results: The mean glucosamine concentration in the synovial fluid of patients from the Test group (100.56 ng/ml, 95% CI 66.36 - 134.76, n = 117) was higher than in the Control group (17.83 ng/ml, 95% CI 7.42 - 28.24, n = 117) resulting in a significant between-group difference (p Conclusion: The results suggest that glucosamine can be topically delivered across the human skin into the synovial fluid using a proper vehicle. This suggests that other water-soluble molecules could similarly be delivered transdermally, alleviating the need for oral delivery in cases where oral administration is difficult, or when harmful side effects could ensue.

Target-based approach for osteoarthritis treatment

There is still no definitive treatment for knee osteoarthritis(OA). We are certainly far from a consensus on the best form of treatment or on an effective treatment recommendation. There are reasons for the current equivocal treatment recommendations in the face of this very serious health problem. The greatest of these reasons, undoubtedly, is the great complexity of the factors involved in the development and progression of knee OA and the complex pathophysiology including mechanical, inflammatory, metabolic, post-traumatic, molecular,genetic, and psychological changes. For several years, an attempt has been made to correlate different patient phenotypes to different patterns of response to treatment, thus creating the possibility of developing specific treatments for certain groups of patients and theoretically allowing better treatment efficacy.However, in practice we still find totally different responses and evolutions even in individuals belonging to the same phenotype. Thus, classification by phenotypes, despite being an advance, is not sufficient. The present article proposes a fragmented look at each of the many factors or targets involved in the genesis and evolution of OA. Therefore, we propose not the treatment of OA per se but the management of an individual set of targets to achieve personalized OA management. We believe that, paradoxically, by fragmenting the view of the disease we will be able to treat our patients more holistically in an individualized way.