Since a clear definition of early osteoarthritis (EOA) has not been set up, some critical questions concern its diagnosis and treatment. The upcoming of newly available drugs and innovative therapeutic approaches, such as regenerative medicine, foster a better knowledge of the problem by medical community. We have carried out an updated systematic review on both PubMed and Embase databases, searching for all the studies and researches published in medical literature in the last 32 years, addressing the issue of EOA definition, diagnosis, and treatment, with a special focus on EOA at hip and knee. Our review found out 211 and 447 (published from 1973 to 2015) articles, when searching on PubMed and Embase database, respectively. Among the 132 papers that met our inclusion criteria, only 1 article explicitly addressed the issue of EOA definition, but it was only an expert opinion, while all the other researches were focused on diagnosis or management of EOA. EOA has been defined with regards to the younger age of osteoarthritis onset and radiological damage (grade I–II of the Kellgren and Lawrence classification). A more clear classification of EOA, based on characteristics and symptoms of affected patients, should be delivered by scientific community in order to better identify subjects who might benefit from new expensive drugs and innovative therapeutic approaches.
BACKGROUND: Degenerative osteoarthritis of the knee (OA) affects 35% of persons older than 65 years. If pain persists after non-invasive treatment, some intra-articular drugs can be tried before surgical treatment.
QUESTIONS/PURPOSES: The purpose of this article is to review the literature after 2006 with the aim of answering two questions: (1) Are intra-articular injections of corticosteroids (CS), hyaluronic acid (HA) and platelet-rich plasma (PRP) effective in painful knee OA? and (2) Which of these drugs is more effective?
METHODS: The search engines were MedLine and the Cochrane Library. The keywords used were: knee, osteoarthritis, and intra-articular injections. Eight hundred and forty-four articles were found but only 142 had been published after 2006. Of those, only 14 were selected and reviewed because they were strictly focused on the topic and the questions of this article.
RESULTS: The clinical efficacy of intra-articular injections of HA and CS in patients with knee OA has been demonstrated. Pain reduction after three to five weekly injections of HA lasts between 5 to13 weeks (sometimes up to 1 year). Pain reduction is less durable after CS injections (2 to 3 weeks). Recent reports indicate that PRP could have a better performance than HA in younger patients.
CONCLUSIONS: Three to five weekly intra-articular injections of HA are recommendable in patients with knee OA before surgical treatment. CS injections have a very short effect. The efficacy and duration of PRP injections require further studies.
Since a clear definition of early osteoarthritis (EOA) has not been set up, some critical questions concern its diagnosis and treatment. The upcoming of newly available drugs and innovative therapeutic approaches, such as regenerative medicine, foster a better knowledge of the problem by medical community. We have carried out an updated systematic review on both PubMed and Embase databases, searching for all the studies and researches published in medical literature in the last 32 years, addressing the issue of EOA definition, diagnosis, and treatment, with a special focus on EOA at hip and knee. Our review found out 211 and 447 (published from 1973 to 2015) articles, when searching on PubMed and Embase database, respectively. Among the 132 papers that met our inclusion criteria, only 1 article explicitly addressed the issue of EOA definition, but it was only an expert opinion, while all the other researches were focused on diagnosis or management of EOA. EOA has been defined with regards to the younger age of osteoarthritis onset and radiological damage (grade I–II of the Kellgren and Lawrence classification). A more clear classification of EOA, based on characteristics and symptoms of affected patients, should be delivered by scientific community in order to better identify subjects who might benefit from new expensive drugs and innovative therapeutic approaches.
