nSTRIDE Injections: What They Are, How They Work, and Benefits for Knee Osteoarthritis

What is an nSTRIDE Injection?

nSTRIDE is an autologous protein solution (APS) injection derived from a patient's own blood, designed to treat pain and symptoms associated with knee osteoarthritis by delivering highly concentrated anti-inflammatory proteins and anabolic growth factors directly into the joint.

Understanding Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis, affecting millions worldwide. It is a chronic, progressive degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone. This leads to pain, stiffness, swelling, and reduced range of motion, significantly impacting quality of life. While it can affect any joint, the knees are particularly susceptible due to the weight-bearing demands placed upon them. Current treatments focus on managing symptoms, slowing progression, and improving joint function, ranging from conservative measures like physical therapy and medication to surgical interventions.

What is nSTRIDE?

nSTRIDE is an innovative, minimally invasive treatment option for knee osteoarthritis, specifically designed to address the inflammatory and degenerative processes within the joint. It stands for "autologous protein solution" (APS) and is derived directly from the patient's own blood, making it an autologous (self-derived) therapy.

Mechanism of Action

The nSTRIDE system works by concentrating specific beneficial components from the patient's blood that are crucial for joint health and healing. When injected into the osteoarthritic knee, these components exert a multi-faceted therapeutic effect:

• Anti-Inflammatory Action: The solution contains a high concentration of anti-inflammatory proteins, most notably the Interleukin-1 Receptor Antagonist (IL-1Ra). Interleukin-1 (IL-1) is a key pro-inflammatory cytokine that plays a central role in cartilage degradation in OA. IL-1Ra blocks the action of IL-1, thereby reducing inflammation and pain within the joint.
• Catabolic Enzyme Inhibition: Beyond IL-1Ra, nSTRIDE also provides other proteins that help inhibit the activity of catabolic enzymes (e.g., matrix metalloproteinases or MMPs) that break down cartilage tissue.
• Anabolic Support: The solution also contains various growth factors (e.g., PDGF, TGF-β, IGF-1) that promote tissue repair and regeneration. These growth factors stimulate the production of new cartilage components and may help maintain the integrity of existing cartilage.

Components of the Injection

The nSTRIDE injection is primarily composed of:

• Autologous Blood Plasma: The liquid component of blood.
• Concentrated Platelets: Although not primarily a PRP (Platelet-Rich Plasma) treatment, the process does concentrate platelets, which are rich in growth factors.
• High Concentrations of Anti-Inflammatory Proteins: Especially IL-1Ra.
• Anabolic Growth Factors: Proteins that promote tissue growth and repair.

The nSTRIDE Procedure

The nSTRIDE injection procedure is typically performed in a clinical setting and involves three main steps:

1. Blood Draw: A small amount of blood (usually 55 mL) is drawn from the patient, similar to a standard blood test.
2. Processing: The drawn blood is then placed into the nSTRIDE processing device. This device uses a specialized centrifuge to separate and concentrate the beneficial anti-inflammatory proteins and growth factors from the other blood components. This process typically takes about 20 minutes.
3. Injection: Once processed, the concentrated autologous protein solution is carefully injected directly into the affected knee joint, often guided by ultrasound or fluoroscopy to ensure precise placement.

The entire procedure is usually completed within 30-60 minutes, and patients can typically return home the same day. Post-injection care usually involves a period of rest and modified activity, followed by a gradual return to normal activities, often complemented by physical therapy.

Who is a Candidate for nSTRIDE?

nSTRIDE is generally considered for individuals with mild to moderate knee osteoarthritis who:

• Are experiencing persistent knee pain and functional limitations due to OA.
• Have not found sufficient relief from more conservative treatments such as oral medications (NSAIDs), physical therapy, or corticosteroid injections.
• Are seeking a non-surgical alternative to manage their OA symptoms.
• Prefer an autologous treatment derived from their own body.

It is important to note that nSTRIDE is not typically recommended for severe osteoarthritis where there is significant bone-on-bone contact or extensive cartilage loss, as the potential for benefit may be limited in such advanced cases.

Potential Benefits of nSTRIDE

Patients receiving nSTRIDE injections may experience several potential benefits:

• Significant Pain Reduction: By reducing inflammation and promoting a healthier joint environment, nSTRIDE can lead to a substantial decrease in knee pain.
• Improved Joint Function: Reduced pain and inflammation can lead to better mobility, increased range of motion, and improved ability to perform daily activities.
• Delayed Progression of OA: By inhibiting catabolic processes and supporting anabolic ones, nSTRIDE may potentially slow down the degenerative changes associated with osteoarthritis.
• Long-Lasting Effects: Clinical studies have indicated that a single nSTRIDE injection can provide pain relief and functional improvement for up to 12 months, and in some cases, even longer.
• Autologous and Safe: Since the solution is derived from the patient's own blood, the risk of allergic reactions or disease transmission is virtually eliminated.

Potential Risks and Side Effects

As with any medical procedure, nSTRIDE injections carry some potential risks and side effects, though they are generally mild and temporary:

• Injection Site Pain: Temporary pain, swelling, or bruising at the injection site is common.
• Joint Stiffness or Swelling: Some patients may experience a temporary increase in joint stiffness or swelling immediately following the injection.
• Infection: As with any injection into a joint, there is a very small risk of infection, though strict sterile techniques are used to minimize this.
• Nerve or Blood Vessel Damage: Extremely rare, but possible with any injection.

Serious complications are rare. It is crucial to discuss all potential risks and benefits with your healthcare provider before undergoing the procedure.

nSTRIDE vs. Other Treatments

nSTRIDE fits into the spectrum of osteoarthritis treatments, offering a unique approach compared to other common interventions:

• Corticosteroid Injections: Provide potent anti-inflammatory effects but are typically short-lived (weeks to a few months) and can have catabolic effects on cartilage with repeated use. nSTRIDE aims for longer-term anti-inflammatory and potentially anabolic effects.
• Hyaluronic Acid (Viscosupplementation) Injections: Involve injecting a gel-like substance to lubricate the joint and provide shock absorption. While they can offer pain relief, their primary mechanism is mechanical, whereas nSTRIDE focuses on biological modulation of the joint environment.
• Platelet-Rich Plasma (PRP) Injections: Also autologous, PRP concentrates platelets to deliver a high dose of growth factors. While similar in concept, nSTRIDE specifically focuses on concentrating anti-inflammatory proteins (like IL-1Ra) in addition to growth factors, which distinguishes its primary mechanism of action.
• Surgical Options (e.g., Joint Replacement): These are considered end-stage treatments for severe OA. nSTRIDE is a non-surgical option aimed at delaying or potentially avoiding surgery in earlier stages of the disease.

Evidence and Research

Clinical studies and trials have investigated the efficacy and safety of nSTRIDE. Research has shown that nSTRIDE can significantly reduce pain and improve function in patients with knee OA, with effects lasting up to 12 months or more after a single injection. Studies often compare its outcomes to saline placebos or other standard treatments, demonstrating its therapeutic potential. Continued research aims to further elucidate its long-term benefits and optimal patient selection criteria.

Important Considerations

• Consultation with a Specialist: Before considering nSTRIDE, it is essential to consult with an orthopedic specialist, sports medicine physician, or physiatrist who can accurately diagnose your condition and determine if nSTRIDE is an appropriate treatment option for you.
• Not a Cure: nSTRIDE is a treatment for the symptoms and progression of osteoarthritis; it is not a cure and will not regenerate lost cartilage entirely.
• Part of a Comprehensive Plan: For optimal results, nSTRIDE should often be integrated into a broader management plan that may include physical therapy, exercise, weight management, and other lifestyle modifications.
• Individual Results Vary: While many patients experience significant relief, individual responses to nSTRIDE can vary.

nSTRIDE represents an exciting advancement in the non-surgical management of knee osteoarthritis, offering a biologically-driven approach to reduce pain, improve function, and potentially slow disease progression by harnessing the body's own healing and anti-inflammatory capabilities.