Osteoarthritis
Osteoarthritis (OA) is a chronic, progressive joint disorder characterized by the degeneration of articular cartilage, subchondral bone remodeling, and synovial inflammation, ultimately leading to pain, stiffness, and loss of joint function. The pathogenesis of OA is multifactorial, involving mechanical stress, biochemical changes, genetic predisposition, and inflammatory mediators that disrupt the balance between cartilage synthesis and degradation. Chondrocyte dysfunction, increased production of matrix metalloproteinases, and pro-inflammatory cytokines contribute to cartilage breakdown and joint tissue damage. OA primarily affects weight-bearing joints such as the knees, hips, and spine, but can also involve the hands and other joints. The health impacts of OA are substantial, including chronic pain, decreased mobility, impaired quality of life, increased risk of comorbidities such as cardiovascular disease, and significant socioeconomic burden due to disability and healthcare utilization.
Primary osteoarthritis, also known as idiopathic osteoarthritis, develops without any identifiable underlying cause and is most commonly associated with aging and genetic factors. It typically affects the hands, knees, hips, and spine, and is characterized by gradual onset of joint pain, stiffness, and functional limitation. The disease progression is usually slow, and risk factors include advanced age, female sex, obesity, and family history.
Secondary osteoarthritis arises as a consequence of predisposing factors or underlying conditions that alter the normal structure or function of the joint. These may include previous joint injury or trauma, congenital or developmental disorders, metabolic diseases (such as hemochromatosis or acromegaly), inflammatory joint diseases, or chronic mechanical overload. Secondary OA can develop at a younger age and may affect atypical joints depending on the underlying cause.
Erosive osteoarthritis is a more aggressive and inflammatory subset of OA, predominantly affecting the interphalangeal joints of the hands. It is characterized by episodic joint inflammation, central erosions, and rapid joint destruction, often leading to marked pain, swelling, and deformity. Radiographically, erosive OA is distinguished by the presence of central erosions and 'gull-wing' deformities.
Generalized osteoarthritis refers to the involvement of multiple joint sites, often including the hands, knees, hips, and spine. This form is frequently seen in older adults and is associated with a genetic predisposition. Generalized OA may present with Heberden’s and Bouchard’s nodes in the fingers and can be associated with more severe functional impairment.
Post-traumatic osteoarthritis develops following acute or repetitive joint injury, such as fractures, ligament tears, or meniscal damage. The altered biomechanics and joint instability resulting from the injury accelerate cartilage degeneration and predispose the affected joint to early-onset OA. This type is commonly observed in younger, physically active individuals and may progress more rapidly than primary OA.
Osteoarthritis is the most prevalent form of arthritis worldwide, affecting an estimated 240 million people globally. The prevalence increases markedly with age, with symptomatic knee OA affecting approximately 10% of men and 13% of women aged 60 years and older. Women are more frequently affected than men, particularly after menopause. OA is a leading cause of disability among older adults, accounting for a significant proportion of years lived with disability. Population-based studies indicate that radiographic evidence of OA is present in up to 80% of individuals over the age of 75, although not all exhibit clinical symptoms. Risk factors for OA include advanced age, female sex, obesity, previous joint injury, repetitive joint use, genetic susceptibility, and metabolic disorders. The disease imposes a substantial economic burden due to direct healthcare costs and indirect costs related to loss of productivity and long-term disability.
The diagnosis of osteoarthritis is primarily clinical, based on the presence of characteristic symptoms such as joint pain, stiffness (especially after periods of inactivity or in the morning), and functional limitation, often affecting weight-bearing joints. Physical examination may reveal joint tenderness, crepitus, bony enlargement, reduced range of motion, and, in advanced cases, joint deformity. Radiographic evaluation is the mainstay of diagnostic confirmation, with typical findings including joint space narrowing, osteophyte formation, subchondral sclerosis, and cysts. The American College of Rheumatology (ACR) has established classification criteria for OA of the hand, knee, and hip, which combine clinical, laboratory, and imaging features. Laboratory tests are generally not required for diagnosis but may be used to exclude other causes of joint symptoms, such as rheumatoid arthritis or crystal arthropathies. Synovial fluid analysis may be performed to rule out infection or inflammatory arthritis if the diagnosis is uncertain. Advanced imaging modalities, such as MRI, can provide detailed assessment of cartilage, menisci, and subchondral bone, but are not routinely indicated for typical cases. Early and accurate diagnosis is essential for optimal management and prevention of disease progression.
Among the pharmacological interventions available for osteoarthritis, diclofenac etalhyaluronate is utilized as an intra-articular agent, combining the anti-inflammatory effects of diclofenac with the viscosupplementation properties of hyaluronate to alleviate joint pain and improve mobility. TissueGene-C, also known as tonogenchoncel-L, represents a cell-mediated therapy designed to deliver therapeutic proteins directly to the affected joint, aiming to promote cartilage regeneration and modify disease progression. The combination of hyaluronate sodium and triamcinolone hexacetonide provides both lubrication and potent corticosteroid-mediated anti-inflammatory action through intra-articular administration, offering symptomatic relief in patients with joint inflammation and pain. Esflurbiprofen, the (S)-(+)-enantiomer of flurbiprofen, is administered as a nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation associated with osteoarthritis. Polmacoxib is a selective cyclooxygenase-2 (COX-2) inhibitor, prescribed for its efficacy in decreasing inflammatory pain while minimizing gastrointestinal side effects commonly associated with traditional NSAIDs. Chung-pa-juhn, also referred to as chungpa-juhn or shinbaro, is an agent used in osteoarthritis management, with its therapeutic effects targeting joint pain and functional improvement. The fixed-dose combination of ibuprofen and famotidine allows for NSAID-mediated analgesia with concurrent gastric protection provided by the histamine H2 receptor antagonist famotidine, thereby reducing the risk of gastrointestinal complications during long-term therapy. Zucapsaicin, also known as (Z)-capsaicin or civamide, is a topical agent applied to the affected joint area to provide analgesic effects through modulation of nociceptive nerve activity. Lastly, the combination of ketoprofen and omeprazole offers anti-inflammatory and analgesic benefits of ketoprofen, another NSAID, while omeprazole, a proton pump inhibitor, serves to protect the gastrointestinal mucosa from NSAID-induced damage. These pharmacotherapeutic options address the multifaceted symptomatology of osteoarthritis and are selected based on individual patient needs, comorbidities, and risk profiles.
| Structure | Generic Name | CAS Registry Number | Molecular Formula | Molecular Weight |
|---|---|---|---|---|
| diclofenac etalhyaluronate (USAN) | 1608089-20-8 | |||
| tissueGene-C; tonogenchoncel-L (USAN) | ||||
| hyaluronate sodium/triamcinolone hexacetonide | ||||
 | (S)-(+)-flurbiprofen; esflurbiprofen (Rec INN; BAN) | 51543-39-6 | C15 H13 F O2 | 244.261 |
 | polmacoxib (Prop INN; USAN) | 301692-76-2 | C18 H16 F N O4 S | 361.387 |
| chung-pa-juhn; chungpa-juhn; shinbaro | ||||
| ibuprofen/famotidine | ||||
 | (Z)-capsaicin; civamide; zucapsaicin (Rec INN; USAN) | 25775-90-0 | C18 H27 N O3 | 305.412 |
| ketoprofen/omeprazole |
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