Nstride Injection: A Biologic Therapy for Osteoarthritis Pain and Progression

What is Nstride injection?

Nstride is an autologous protein solution (APS) derived from a patient's own blood, designed to treat osteoarthritis by concentrating anti-inflammatory proteins and anabolic growth factors to reduce pain and potentially slow cartilage degeneration.

Understanding Osteoarthritis

Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the breakdown of joint cartilage, leading to pain, stiffness, and reduced mobility. It's the most common form of arthritis, affecting millions worldwide, often in weight-bearing joints like the knees and hips, but also in the hands and spine. The disease involves not only cartilage loss but also inflammation of the synovial membrane, bone changes, and muscle weakness, collectively impacting joint function and quality of life. Traditional treatments range from lifestyle modifications and physical therapy to medications (NSAIDs, corticosteroids) and, in severe cases, joint replacement surgery.

What is Nstride Injection?

Nstride Autologous Protein Solution (APS) is a cutting-edge biologic therapy that utilizes the patient's own blood to create a concentrated solution rich in beneficial proteins. Unlike traditional steroid injections that primarily suppress inflammation, Nstride aims to address the underlying pathology of osteoarthritis by modulating the inflammatory environment and promoting tissue health.

Key Components: The Nstride system processes a small sample of the patient's venous blood to concentrate specific therapeutic components:

• Anti-inflammatory Proteins: Primarily Interleukin-1 Receptor Antagonist (IL-1Ra), which blocks the action of Interleukin-1 (IL-1), a major pro-inflammatory cytokine responsible for cartilage breakdown in OA. Other anti-inflammatory cytokines are also present.
• Anabolic Growth Factors: Various growth factors that support cartilage health and repair, such as Platelet-Derived Growth Factor (PDGF), Transforming Growth Factor-beta (TGF-β), and Insulin-like Growth Factor-1 (IGF-1).

Mechanism of Action: When injected into an osteoarthritic joint, the Nstride solution works on multiple fronts:

• Reduces Inflammation: The high concentration of IL-1Ra directly competes with and blocks IL-1 from binding to its receptors on joint cells, effectively neutralizing a key driver of inflammation and cartilage degradation.
• Promotes Tissue Homeostasis: The growth factors present in the solution stimulate chondrocytes (cartilage cells) and synoviocytes (cells lining the joint capsule) to maintain and repair the extracellular matrix of cartilage, potentially slowing the degenerative process.
• Pain Modulation: By reducing inflammation and promoting a healthier joint environment, Nstride helps alleviate pain, which is often a direct consequence of inflammatory processes and mechanical stress on damaged joint tissues.

How Nstride Differs from Traditional Treatments

Nstride stands apart from other common intra-articular injections due to its comprehensive biological action:

• Corticosteroid Injections: While effective for short-term pain relief by suppressing inflammation, corticosteroids do not address the underlying cartilage damage and can, with repeated use, have catabolic effects on cartilage and other joint tissues. Nstride, conversely, aims to be both anti-inflammatory and anabolic.
• Hyaluronic Acid (Viscosupplementation): These injections aim to replenish the joint's natural lubricating fluid and provide some shock absorption. While they can offer symptomatic relief, they do not typically modulate the inflammatory cascade or promote tissue repair in the same manner as Nstride.
• Platelet-Rich Plasma (PRP): PRP therapy also uses the patient's own blood but primarily concentrates platelets, which then release growth factors. While PRP has shown promise, Nstride is specifically designed to provide a much higher concentration of anti-inflammatory proteins like IL-1Ra, in addition to growth factors, offering a more targeted approach to both inflammation and degeneration in OA.

The Procedure: What to Expect

The Nstride injection procedure is typically performed in an outpatient setting and involves three main steps:

• Blood Draw: A small volume of blood (typically 55 mL) is drawn from the patient's arm, similar to a standard blood test.
• Blood Processing: The collected blood is then placed into the Nstride processing system, which uses a specialized centrifuge to separate and concentrate the desired anti-inflammatory proteins and growth factors into the autologous protein solution (APS). This process takes approximately 20-30 minutes.
• Joint Injection: Once the solution is prepared, it is carefully injected directly into the affected joint, most commonly the knee. To ensure precise placement and maximize efficacy, the injection is almost always performed under ultrasound guidance.

Post-Injection Care: Patients are usually advised to limit strenuous activity for a few days post-injection and may experience mild soreness or swelling at the injection site, which typically resolves quickly.

Potential Benefits and Efficacy

Clinical studies and real-world application suggest several potential benefits of Nstride for osteoarthritis patients:

• Significant Pain Reduction: Many patients report a substantial decrease in joint pain, often lasting for an extended period.
• Improved Joint Function: Reduced pain and inflammation can lead to better mobility, increased range of motion, and enhanced ability to perform daily activities.
• Potential for Disease Modification: By targeting the inflammatory pathways and promoting a healthier joint environment, Nstride holds the promise of slowing the progression of cartilage degeneration, rather than just masking symptoms.
• Long-Lasting Effects: While individual results vary, some studies indicate pain relief and functional improvement lasting up to 12 months or longer after a single injection.

Potential Risks and Side Effects

As with any medical procedure, Nstride injections carry some potential risks, though they are generally considered safe:

• Injection Site Reactions: The most common side effects include temporary pain, swelling, bruising, or redness at the injection site.
• Infection: Although rare, there is a small risk of infection whenever the skin barrier is broken.
• Allergic Reaction: Since the solution is derived from the patient's own blood, the risk of a severe allergic reaction is extremely low.
• No Improvement: Not all patients respond to the treatment, and some may experience minimal or no benefit.

Who is a Candidate for Nstride?

Nstride is typically considered for individuals with mild to moderate osteoarthritis who:

• Have not found sufficient relief from conservative treatments like physical therapy, oral medications, or other injections (e.g., corticosteroids, hyaluronic acid).
• Are looking for a non-surgical option to manage their OA symptoms and potentially slow disease progression.
• Are not candidates for, or wish to delay, joint replacement surgery.
• Are in good general health with no contraindications to blood draws or injections.

It is crucial for a qualified healthcare professional, such as an orthopedic surgeon, sports medicine physician, or physiatrist, to assess candidacy based on the individual's specific condition and medical history.

Important Considerations and Limitations

While Nstride represents a promising advancement in OA treatment, it's important to acknowledge its limitations:

• Not a Cure: Nstride is not a cure for osteoarthritis. It aims to manage symptoms and potentially slow progression, but it does not regenerate lost cartilage or reverse advanced joint damage.
• Variable Efficacy: Response to treatment can vary significantly among individuals.
• Cost: Nstride injections can be expensive, and coverage by insurance plans varies widely, as it is still considered a relatively new and evolving therapy.
• Long-Term Research: While initial studies are positive, more extensive, long-term research is ongoing to fully understand its efficacy and role in the comprehensive management of osteoarthritis.

Conclusion

Nstride injection offers an innovative, biologically-driven approach to managing osteoarthritis. By harnessing the body's natural healing and anti-inflammatory mechanisms, it aims to reduce pain, improve function, and potentially modify the disease course. As research continues to evolve, Nstride is establishing itself as a valuable option for many individuals seeking effective, non-surgical relief from the challenges of osteoarthritis. Patients considering Nstride should have a thorough discussion with their healthcare provider to determine if it is the right treatment option for their specific condition.