The University of Southampton
University of Southampton Institutional Repository

Alternative and complementary therapies in osteoarthritis and cartilage repair

Alternative and complementary therapies in osteoarthritis and cartilage repair
Alternative and complementary therapies in osteoarthritis and cartilage repair
Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.
Alternative, Cartilage, Herbal, Osteoarthritis, Therapy, Treatment
1594-0667
547-560
Fuggle, Nicholas
9ab0c81a-ac67-41c4-8860-23e0fdb1a900
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Oreffo, Richard
ff9fff72-6855-4d0f-bfb2-311d0e8f3778
Price, A.J.
d38e827f-588c-47f8-9590-ce8790423e2c
Kaux, J.F.
f2e25771-ee27-4a18-8c3e-76586099da32
Maheu, E.
258667ce-c895-45f8-addc-de975ae1863e
Cutolo, M.
0ad3c578-04c3-40fe-a207-5774fa1a7f5d
Honvo, G.
cae0c093-3ac8-4ce6-8a6c-ac99cab9343d
Conaghan, P.G.
fcfa7b96-7335-4cab-a643-faa6e400b47d
Berenbaum, F.
a8d87cb7-9eca-4517-ae91-f83a7f9ac4aa
Branco, J.
f1c58fe8-c26b-4d12-8205-253b0fcd3ff4
Brandi, M.L.
4147f967-9c22-494d-ae35-c8141161413d
Cortet, B.
1ca3d953-f9fe-4fba-a189-7f610a1c8b09
Veronese, N.
71183b2d-fed2-4fda-a79f-b2560457fdad
Kurth, A.A.
ea9e8653-d1ef-4311-814e-541e1c766d49
Matijevic, R.
2a125cff-4fec-4a1e-8471-5b870f4c8c93
Roth, R.
9a9ea648-1b5e-417b-8bc7-449c86b47de5
Pelletier, J.P.
6ede80e5-dcc8-4b0c-a292-792f067b8ace
Martel-Pelletier, J.
f35bfb7f-d2c4-4f42-8218-cfdad2fc55b7
Vlaskovska, M.
53876905-f74e-49fb-817c-ff064a5a40ef
Thomas, T.
a730aea1-d9bc-4561-bd76-bf43ce200861
Lems, W.F.
53426263-c1f1-45d1-b1a0-6bcc8b2677a0
Al-Daghri, N.
21272a0a-ffb4-4380-a04f-e4d9cc2e7f3c
Bruyere, O.
9c455ea4-7f77-407f-ab5a-ecb571db8245
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Reginster, J.Y.
4083b457-5347-4ece-a53e-af19c8868c42
Fuggle, Nicholas
9ab0c81a-ac67-41c4-8860-23e0fdb1a900
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Oreffo, Richard
ff9fff72-6855-4d0f-bfb2-311d0e8f3778
Price, A.J.
d38e827f-588c-47f8-9590-ce8790423e2c
Kaux, J.F.
f2e25771-ee27-4a18-8c3e-76586099da32
Maheu, E.
258667ce-c895-45f8-addc-de975ae1863e
Cutolo, M.
0ad3c578-04c3-40fe-a207-5774fa1a7f5d
Honvo, G.
cae0c093-3ac8-4ce6-8a6c-ac99cab9343d
Conaghan, P.G.
fcfa7b96-7335-4cab-a643-faa6e400b47d
Berenbaum, F.
a8d87cb7-9eca-4517-ae91-f83a7f9ac4aa
Branco, J.
f1c58fe8-c26b-4d12-8205-253b0fcd3ff4
Brandi, M.L.
4147f967-9c22-494d-ae35-c8141161413d
Cortet, B.
1ca3d953-f9fe-4fba-a189-7f610a1c8b09
Veronese, N.
71183b2d-fed2-4fda-a79f-b2560457fdad
Kurth, A.A.
ea9e8653-d1ef-4311-814e-541e1c766d49
Matijevic, R.
2a125cff-4fec-4a1e-8471-5b870f4c8c93
Roth, R.
9a9ea648-1b5e-417b-8bc7-449c86b47de5
Pelletier, J.P.
6ede80e5-dcc8-4b0c-a292-792f067b8ace
Martel-Pelletier, J.
f35bfb7f-d2c4-4f42-8218-cfdad2fc55b7
Vlaskovska, M.
53876905-f74e-49fb-817c-ff064a5a40ef
Thomas, T.
a730aea1-d9bc-4561-bd76-bf43ce200861
Lems, W.F.
53426263-c1f1-45d1-b1a0-6bcc8b2677a0
Al-Daghri, N.
21272a0a-ffb4-4380-a04f-e4d9cc2e7f3c
Bruyere, O.
9c455ea4-7f77-407f-ab5a-ecb571db8245
Rizzoli, R.
2214fb77-8fb7-4c0b-bfc4-9f8d3cace5d7
Kanis, J.A.
8da04a36-08a7-4310-b4b4-a6d432439587
Reginster, J.Y.
4083b457-5347-4ece-a53e-af19c8868c42

Fuggle, Nicholas, Cooper, Cyrus, Oreffo, Richard, Price, A.J., Kaux, J.F., Maheu, E., Cutolo, M., Honvo, G., Conaghan, P.G., Berenbaum, F., Branco, J., Brandi, M.L., Cortet, B., Veronese, N., Kurth, A.A., Matijevic, R., Roth, R., Pelletier, J.P., Martel-Pelletier, J., Vlaskovska, M., Thomas, T., Lems, W.F., Al-Daghri, N., Bruyere, O., Rizzoli, R., Kanis, J.A. and Reginster, J.Y. (2020) Alternative and complementary therapies in osteoarthritis and cartilage repair. Aging Clinical and Experimental Research, 32 (4), 547-560. (doi:10.1007/s40520-020-01515-1).

Record type: Review

Abstract

Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects.

Text
Alt therapies in OA, ACER Manuscript 20_03_05 - Accepted Manuscript
Download (203kB)
Text
Fuggle 2020 Article Alternative And Complementary - Version of Record
Available under License Creative Commons Attribution.
Download (928kB)

More information

Accepted/In Press date: 14 February 2020
e-pub ahead of print date: 13 March 2020
Published date: 1 April 2020
Additional Information: Funding Information: The ESCEO Working Group was funded by the ESCEO. The ESCEO receives unrestricted educational grants to support its educational and scientific activities from non-governmental organizations, not-for-profit organizations, non-commercial or corporate partners. The choice of topics, participants, content and agenda of the Working Groups as well as the writing, editing, submission and reviewing of the manuscript are the sole responsibility of the ESCEO, without any influence from third parties. Funding Information: PGC is supported in part by the National Institute for Health Research (NIHR) infrastructure at Leeds. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: NRF, ROCO, AJP, JFK, MC, GH, JB, NV, AAK, RM, MV, WL, RRo, NA-D and RRi have no relevant conflicts of interest to declare. CC has received lecture fees and honoraria from Amgen, Danone, Eli Lilly, GSK, Kyowa Kirin, Medtronic, Merck, Nestlé, Novartis, Pfizer, Roche, Servier, Shire, Takeda and UCB outside of the submitted work. EM reports personal fees from Expanscience, personal fees from Mylan - Meda, personal fees from TRB Chemedica, Pierre Fabre, Celgène and Fidia, and non-financial support from Pfizer, outside the submitted work. PGC reports personal fees from AbbVie, personal fees from Flexion Therapeutics, personal fees from Galapagos, personal fees from GlaxoSmithKline, personal fees from Novartis, personal fees from Pfizer, personal fees from Samumed, outside the submitted work. FB reports personal fees from 4P Pharma, Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Heel, Merck Sereno, MSD, Nordic, Novartis, Peptinov, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, TRB Chemedica, UCB. MLB reports grants and honoraria from AMGEN, grants from ABIOGEN, grants and consultancy from ALEXION, grants, consultant and honoraria from BRUNO FARMACEUTICI, grants from ELI LILLY, grants, consultancy and honoraria from KYOWA KIRIN, grants from MSD, grants from NPS, grants and consultant from SERVIER, grants and consultancy from SHIRE, outside the submitted work. BC reports grants and sponsorship from MSD, consultancy for Amgen and occasional interventions for Lilly, Roshe, Ferring and Expanscience. JPP reports personal fees from Mylan, grant and personal fees from TRB Chemedica, outside the submitted work. JMP reports grant and personal fees from TRB Chemedica, outside the submitted work. TT reports personal fees from Abbvie, grants and personal fees from Amgen, personal fees from Arrow, personal fees from Biogen, personal fees from BMS, grants and personal fees from Chugai, personal fees from Expanscience, personal fees from Gilead, personal fees from Grunenthal, grants and personal fees from HAC-Pharma, personal fees from LCA, personal fees from Lilly, personal fees from Medac, grants and personal fees from MSD, grants and personal fees from Novartis, grants and personal fees from Pfizer, personal fees from Sanofi, personal fees from Theramex, personal fees from Thuasne, personal fees from TEVA, grants and personal fees from UCB, grants from Bone therapeutics, outside the submitted work. OB reports grants from Biophytis, IBSA, MEDA, Servier, SMB, Theramex, outside the submitted work. JAK reports grants from UCB, grants from Amgen, grants from Radius Health, outside the submitted work. JYR reports grants and personal fees from IBSA-GENEVRIER, grants and personal fees from MYLAN, grants and personal fees from RADIUS HEALTH, personal fees from PIERRE FABRE, grants from CNIEL, personal fees from DAIRY RESEARCH COUNCIL (DRC), outside the submitted work. Publisher Copyright: © 2020, The Author(s).
Keywords: Alternative, Cartilage, Herbal, Osteoarthritis, Therapy, Treatment

Identifiers

Local EPrints ID: 438555
URI: http://eprints.soton.ac.uk/id/eprint/438555
ISSN: 1594-0667
PURE UUID: 3312b3c3-6666-4e81-adbf-9ed6eb8b9d33
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Richard Oreffo: ORCID iD orcid.org/0000-0001-5995-6726

Catalogue record

Date deposited: 16 Mar 2020 17:36
Last modified: 06 Jul 2022 04:01

Export record

Altmetrics

Contributors

Author: Nicholas Fuggle
Author: Cyrus Cooper ORCID iD
Author: Richard Oreffo ORCID iD
Author: A.J. Price
Author: J.F. Kaux
Author: E. Maheu
Author: M. Cutolo
Author: G. Honvo
Author: P.G. Conaghan
Author: F. Berenbaum
Author: J. Branco
Author: M.L. Brandi
Author: B. Cortet
Author: N. Veronese
Author: A.A. Kurth
Author: R. Matijevic
Author: R. Roth
Author: J.P. Pelletier
Author: J. Martel-Pelletier
Author: M. Vlaskovska
Author: T. Thomas
Author: W.F. Lems
Author: N. Al-Daghri
Author: O. Bruyere
Author: R. Rizzoli
Author: J.A. Kanis
Author: J.Y. Reginster

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×