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

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.

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Alt therapies in OA, ACER Manuscript 20_03_05 - Accepted Manuscript
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Fuggle 2020 Article Alternative And Complementary - Version of Record
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Accepted/In Press date: 14 February 2020
e-pub ahead of print date: 13 March 2020
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: 18 Feb 2021 16:54

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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

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