Quantifying Treatment-Related Inflammatory Change in Knee Osteoarthritis Using Normalized MRI Inflammation Volume (NORMI)

Presenter: O. Kubassova

This Phase 2 randomized, double-blind, placebo-controlled trial enrolled 61 participants with moderate-to-severe knee osteoarthritis (Kellgren-Lawrence grade 2–4) who had an inadequate response to conservative therapy. Patients received twice-weekly injectable pentosan polysulfate sodium (iPPS), once-weekly iPPS, or placebo for 6 weeks, with MRI follow-up at Day 168. Normalized MRI inflammation volume (NORMI) quantified synovitis and bone marrow lesion (BME) burden.

The MRI follow-up at 168 days showed an 18% reduction in BME volume in the iPPS twice-weekly group, compared with a 2% increase in placebo. Femoral BME decreased by 16.1% with twice-weekly iPPS but increased by 77.0% in placebo and 4.1% in once-weekly iPPS. Synovitis rose in placebo (+4.6%) and once-weekly iPPS (+30.1%) but decreased slightly (-1%) with twice-weekly iPPS. NORMI offered a joint-size-independent MRI metric, objectively quantifying inflammation and stratifying osteoarthritis responders.

Expert Consensus on Hyaluronic Acid Injections for Knee Osteoarthritis: A Patient-Centered Approach

Presenter: N. Fuggle

This clinical review highlights intra-articular hyaluronic acid (IAHA) as a therapeutic option for knee osteoarthritis (OA). Hyaluronic acid (HA), a natural synovial fluid constituent, declines progressively during OA.

Evidence from randomized trials, meta-analyses, and umbrella reviews supports IAHA efficacy in improving symptoms, though guidelines remain inconsistent. IAHA is not recommended in acute OA flares. Safety data are generally favorable, with most studies reporting a positive profile, although some meta-analyses suggest increased risk of serious adverse events. Hybrid formulations combining IAHA with agents such as mannitol, sorbitol, chondroitin sulfate, tranexamic acid or polynucleotides show variable added benefit. Patient preference, injection volume, needle gauge, number of injections, and duration of action remain critical considerations.

Osteoarthritis and Hypothyroidism

Presenter: A. Zoto

This observational study examined osteoarthritis (OA) frequency in 80 hypothyroid patients presenting with joint and spine pain. Mean age was 42 years, with mean disease duration of 11 years; 64% were female and 36% male. Radiographic OA was identified in 15% of patients (11% female, 4% male). Distribution included knee OA in 7%, hip OA in 4%, spine OA in 3%, and hand OA in 1%. Elevated thyroid-stimulating hormone (TSH) and free thyroxin (T4) levels were observed in 56%. OA prevalence was higher in patients with elevated TSH/T4 (12%) compared to those with normal levels (3%). Elevated thyroid-stimulating hormone and free thyroxin increase osteoarthritis risk, especially in hypothyroid females.

Intra-Articular Injections for Knee osteoarthritis: A Review of Nonsurgical Strategies

Presenter: T. Chobpenthai

This narrative review synthesizes evidence from network meta-analyses and guidelines (AAOS, OARSI, EULAR) on intra-articular (IA) injections for knee osteoarthritis (OA). Various injectables considered include IA corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), mesenchymal stem cells (MSCs), exosomes, growth factor concentrates (GFC), glucose prolotherapy, saline, and atelocollagen-based therapies.

IA corticosteroids provided rapid pain relief but their repeated use, accelerated cartilage loss, limiting long-term utility. HA, particularly high-molecular-weight formulations, offered modest symptomatic benefit, though superiority over placebo remains debated. PRP often demonstrated greater improvements in pain and function than HA or corticosteroids, with PRP+HA combinations showing enhanced outcomes, though variability in preparation complicates comparisons. Emerging regenerative injectables- BMAC, MSCs, exosomes, growth factors, glucose prolotherapy, and atelocollagen- showed promise but rely on small, heterogeneous studies. IA injections are generally safe, with rare septic arthritis. Robust, long-term trials are urgently needed.

WCO-IOF-ESCEO Congress, April 16-19, 2026, Prague, Czech Republic.