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Alternative and complementary therapies in osteoarthritis and cartilage repair.

  • Fuggle NR MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
  • Cooper C MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK. cc@mrc.soton.ac.uk.
  • Oreffo ROC Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Institute of Developmental Sciences, University of Southampton, Southampton, UK.
  • Price AJ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
  • Kaux JF Department of Physical and Rehabilitation Medicine & Sports Traumatology, FIFA Medical Centre of Excellence, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, FIMS Collaborative Center of Sports Medicine, University Hospital and University of Liège, Liege, Belgium.
  • Maheu E Rheumatology Department, AP-HP, Saint-Antoine Hospital, 4 Blvd. Beaumarchais, Paris, France.
  • Cutolo M Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
  • Honvo G WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium.
  • Conaghan PG Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK.
  • Berenbaum F Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Saint-Antoine Hospital, Paris, France.
  • Branco J Centro Hospitalar de Lisboa Ocidental- Hospital Egas Moniz, Lisbon, Portugal.
  • Brandi ML Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
  • Cortet B Department of Rheumatology and EA 4490, Lille University Hospital, Lille, France.
  • Veronese N National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy.
  • Kurth AA Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Ratingen, Germany.
  • Matijevic R Faculty of Medicine, Clinic for Orthopedic Surgery and Traumatology, Clinical Center of Vojvodina, University of Novi Sad, Novi Sad, Serbia.
  • Roth R Institute of Outdoor Sports and Environmental Science, German Sport University, Cologne, Germany.
  • Pelletier JP Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
  • Martel-Pelletier J Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
  • Vlaskovska M Medical Faculty, Department of Pharmacology, Medical University Sofia, 2, Zdrave Str, 1431, Sofia, Bulgaria.
  • Thomas T Department of Rheumatology, Hôpital Nord, CHU de Saint-Etienne, Saint-Étienne, France.
  • Lems WF Location VU Medical Center, Department of Rheumatology and Immunology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
  • Al-Daghri N Chair for Biomarkers Research, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
  • Bruyère O WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium.
  • Rizzoli R Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
  • Kanis JA Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
  • Reginster JY WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium.
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  • 2020-03-15
Published in:
  • Aging clinical and experimental research. - 2020
Alternative
Cartilage
Herbal
Osteoarthritis
Therapy
Treatment
Age Factors
Chondrocytes
Complementary Therapies
Female
Humans
Male
Mesenchymal Stem Cell Transplantation
Osteoarthritis, Knee
Transplantation, Autologous
Treatment Outcome
Vitamin D
Vitamins
English 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.
Language
  • English
Open access status
hybrid
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Persistent URL
https://folia.unifr.ch/global/documents/229821
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