Update

PENGOBATAN
OSTEOARTRITIS
Dyah Aryani Perwitasari
Fakultas Farmasi
Universitas Ahmad Dahlan
 PRESENTASI

DEFINISI FARMAKOTERAPI TARGETTED THERAPY

TRADITIONAL THERAPY
 DEFINISI

Osteoarthritis (OA) is the most common chronic articular disease and remains one of the few
chronic aging disorders with few effective treatments, none of which have been proven to delay
disease progression.
It can affect small, medium, and large joints, although in terms of a painful disease, the knee is
most frequently affected in up to 10% of men and 13% of women aged above 60 years
TUJUAN TERAPI
INTRA ARTIKULER
IA therapy is more effective than oral
non-steroidal anti-inflammatory drugs
and other systemic pharmacological
treatments;
It has also revealed that some of its
benefits may be secondary to the IA
placebo effect
INTRA ARTIKULER
injectable drug delivery alone, including
new treatments, may not provide
significant benefits for OA treatment.
Because IA injections cannot target the
complexity of the pathological
mechanisms.
It means that relatively new concept is
the multimodal approach to the IA
injections, which is needed to
significant effect on the entire knee
 INTRA-ARTICULAR
CORTICOSTEROID INJECTION

Corticoids act directly on nuclear receptors, disrupting the inflammatory cascade at

several levels, causing immunosuppressive and anti-inflammatory effects.
They are part of the pain relief mechanism and reduce the action and production of
interleukin-1, prostaglandins, leukotriene, MMP9, and MMP-11, which are believed to
increase joint mobility in the knee OA.
The clinical anti-inflammatory effects of these actions include decrease in erythema,
heat, swelling, and tenderness of the inflammatory joints, and increases in relative
viscosity with an increase in hyaluronic acid (HA) concentration .
Therefore, IA corticosteroid injections reduce acute pain episodes and increase joint
mobility, particularly when there is evidence of inflammation and joint effusion during
OA redness.
 INTRA-ARTICULAR HYALURONIC
ACID INJECTION
(VISCOSUPPLEMENTATION)
HA, a viscoelastic mucopolysaccharide component of synovial fluid, is produced from
harvested rooster combs or through in vitro bacterial fermentation.
HA is a high molecular-weight glycosaminoglycan that consists of a repeating
sequence of disaccharide units composed of N-acetyl glucosamine and glucuronic acid
Viscous supplementation through an IA injection of HA is aimed at restoring the
beneficial environment present in non-arthritic joints.
Additionally, the safety profile of such injections for painful knee OA is well
established
 IINTRA-ARTICULAR PLATELET-RICH PLASMA
INJECTION (VISCOSUPPLEMENTATION)

The IA platelet-rich plasma (PRP) injection has emerged as a good treatment for knee
OA. Several randomized controlled trials have been shown that PRP is a safe and
effective treatment.
At this time, IA PRP is not a standard treatment of the knee OA, but it is similar in
efficacy to HA, and appears to be more effective than HA in young, active patients with
low-grade OA
 SURGERY

The goals of surgery for patients with OA are to reduce pain, minimize disability, and
improve quality of life.
Treatment should be individualized according to the functional condition of the
patients, severity of the disease, and nature of the underlying disease.
Surgical intervention for patients with OA is generally performed when a less invasive
treatment is unsuccessful.
Total Knee Arthroplasty, Unicompartmental Knee Arthroplasty, High Tibial Osteotomy
or Femoral Osteotomy, Knee Arthroscopy, Knee Cartilage Repair and Cartilage
Restoration
CELLULER THERAPY
TARGETTED THERAPY
TRADITIONAL THERAPY
 TRADITIONAL THERAPY

Curcumin is extracted from the Chinese herb Curcuma longa which is commonly used
in OA for inflammation and pain relief
Combined injection of curcumin and bone marrow mesenchymal stem cells (BMSCs)
into the OA rat model can enhance the migration and proliferation of chondrocytes,
improve the level of anabolic factors and promote chondrogenesis
the traditional administration still has drawbacks such as multiple dosing and
gastrointestinal side effects, although the study showed better tolerance of curcumin
MMP/pH-responsive DDS loading psoralidin (PSO) which is extracted from pPoralea
corylifolia. Anti-inflammatory and cartilage repair effects in vitro and in vivo test by
regulating PI3K/AKT, MAPK and NF-jB signaling.
Salvianolic acid A (SAA) is extracted from Salvia miltiorrhiza Bunge and it can inhibit
chondrocyte apoptosis and ECM degradation in the OA rat model by restraining NF-jB
signaling and activating TIMP-1 and TIMP-2 to inhibit MMPs
 ARAH PENEMUAN
OBAT

Nano-DDS is an important optimization of

OA topical administration, which realizes
biological functions such as drug
penetration, long-term retention and
sustained release.
By modulating DDS structure, the
encapsulation efficiency of the drug is
greatly improved, which avoid large dose
or frequent administration.
 NANOTECH
Nanotechnology has revealed the great plasticity of new materials in the medical field and
these findings will catalyze new breakthroughs of DDS.
At present, many studies get remarkable results in vitro or ex vivo, but there is still a long way
to go before clinical application.
Each drug delivery strategy needs to be reevaluated for safety, consistency, and clinic
efficiency over long-term clinical studies.
The nanomaterials need to be further optimized to achieve good human adaptability, and the
pharmacokinetics of the drug loading system need to be clarified.
In addition, the structure-function relationship between nanomaterials and different stages
of OA (changes in synovial fluid, cartilage, subchondral bone, muscle, ligament and other
tissues as well as the intraarticular environment) is also important challenge for clinical
conversion.
 PUSTAKA

Perkins K, Sahy W, Beckett RD. Efficacy of Curcuma for Treatment of Osteoarthritis. J Evid Based
Complementary Altern Med. 2017 Jan;22(1):156-165. doi: 10.1177/2156587216636747. Epub 2016
Mar 14. PMID: 26976085; PMCID: PMC5871206.

Mao L, Wu W, Wang M, Guo J, Li H, Zhang S, Xu J, Zou J. Targeted treatment for osteoarthritis: drugs
and delivery system. Drug Deliv. 2021 Dec;28(1):1861-1876. doi: 10.1080/10717544.2021.1971798.
PMID: 34515606; PMCID: PMC8439249.

Jang S, Lee K, Ju JH. Recent Updates of Diagnosis, Pathophysiology, and Treatment on

Osteoarthritis of the Knee. Int J Mol Sci. 2021 Mar 5;22(5):2619. doi: 10.3390/ijms22052619. PMID:
33807695; PMCID: PMC7961389.
THANK YOU