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A great deal of research is done for decades to elucidate the complexity of osteoarthritis pathology and to develop therapeutic strategies with symptom and diseases modifying ability. In the recent years, basic knowledge of the synthesis and mechanism of IL-1β and IL-1ra was determined, which are assumed to play a key role in the pathogenesis of osteoarthritis. Consequently, different therapy approaches (i.e.: ACS, PRP, gene therapy) try to influence the ratio of these two interleukins by substitution of IL-1ra. Nevertheless, there still exist great gaps in the knowledge of IL-1β and IL-1ra concentrations in sound and OA joints and the effect of intraarticular IL-1ra substitution.
The first study aimed to evaluate the concentrations of Interleukin-1 receptor antagonist (IL-1ra) and interleukin-1 beta (IL-1β) in normal and osteoarthritic (OA) joints as well as the influence of joint location and arthrocentesis on these concentrations. It could show that the IL-1ra and IL-1β concentration in metacarpo-/metatarsophalangeal, radiocarpal and talocrural joints did not differ significantly and that arthrocentesis did not increase these cytokine concentrations within 60 minutes after joint puncture. Synovial fluid (SF) IL-1ra and IL-1β concentrations were significantly higher in OA than in normal joints. Thus, a parallel increase of both cytokines seems to be an indicator of joint inflammation. Yet on their own these cytokines are not able to differentiate between healthy joints and different OA stages due to great value ranges and value overlap. Yet it has to be further investigated if in combination with other biomarkers a clearer differentiation of pathologic processes in the joint can be made.
The second study hypothesised that shorter treatment intervals of intraarticular autologous conditioned serum (ACS) injections would more beneficially affect the SF concentrations of IL-1ra, IL-1β and cartilage biomarkers, compared with the traditional weekly treatment intervals in joints suffering from natural OA.
The results indicate that the long-time effect of an ACS treatment given at two-day intervals is characterized by decreased SF IL-1ra, IL-1β, C12C, CP II and CS 846 concentrations and thus an approximation to concentrations in normal joints. This might indicate an improvement in joint inflammation and cartilage degrading processes, which lead to the assumption, that a two-day treatment interval is preferable to the commonly used weekly interval. Yet these findings are of limited significance and have to be proven in future studies with greater sample size and uniform OA pathologies.