Saint Joseph University

Knee osteoarthritis (OA) causes significant chronic pain and disability. Current non-operative treatments are largely symptom-modifying. While intra-articular mesenchymal stem cell (MSC) therapies are promising, randomized controlled trials (RCTs) report inconsistent results due to heterogeneity in cell sources, preparations, and techniques. We searched PubMed, Scopus, Cochrane Library, and Google Scholar through December 10, 2025. Peer-reviewed RCTs evaluating intra-articular stem cell-based therapies for knee OA were included. Primary analyses compared MSCs versus controls across pain, function, structure, and safety. Subgroup and sensitivity analyses explored heterogeneity by preparation, source, comparator, follow-up, age, and injection guidance. Twenty-eight RCTs were included. MSC therapies significantly improved pain: ΔVAS (MD -1.67; p = 0.007), post-treatment VAS (MD -3.55; p = 0.01), and KOOS pain (MD 15.37; p = 0.03). Functional gains occurred in KOOS ADL (MD 12.84; p = 0.04), KOOS sports (MD 11.76; p < 0.001), and KOOS symptoms (MD 15.16; p = 0.02). WOMAC, KOOS quality of life, and Lequesne Index showed no significant differences. Benefits were more consistent with culture-expanded preparations, bone marrow sources, saline controls, and ultrasound guidance. ΔVAS remained significant after excluding short follow-up studies; ΔVAS and KOOS pain remained significant in older cohorts. MRI-based WORMS scores were non-significant, indicating no consistent structural benefit. Safety analyses revealed higher rates of injection-site pain (RR 2.04; p = 0.0005), joint swelling (RR 3.39; p = 0.0003), and other adverse events (RR 1.26; p = 0.01). Serious complications (e.g., infection) were uncommon and non-significant. Current evidence suggests stem cell-based therapies serve a primarily symptom-modifying rather than structure-modifying role. Higher frequencies of local reactions must be weighed against symptomatic benefits. Larger, standardized trials are needed to identify optimal preparations and patient profiles for consistent clinical benefit. • Intra-articular stem cell-based therapies demonstrate modest improvements in pain outcomes in knee osteoarthritis compared with control injections across randomized controlled trials, although results vary across cell preparations, comparators, and study conditions. • Symptomatic and functional improvements were observed in several KOOS domains, particularly activities of daily living, sports, and symptoms, with benefits appearing more consistent in selected subgroups rather than uniformly across all stem cell interventions. • Structural changes on MRI (WORMS) were not significantly improved, suggesting that current evidence supports symptomatic relief rather than consistent disease-modifying effects on joint structure. • Stem cell injections were associated with increased local reactions such as injection-site pain and joint swelling, while serious complications remained uncommon, indicating a generally manageable but non-negligible safety profile.

BackgroundBiosimilars are increasingly used in rheumatology practice; however, knowledge gaps and regulatory uncertainties may affect their acceptance. This study assessed the knowledge, perceptions, and clinical practices related to biosimilars among rheumatologists in the Arab League of Associations for Rheumatology (ArLAR) countries.MethodsA web-based survey of 19 questions, adapted from a European Society for Medical Oncology (ESMO) tool, was distributed among ArLAR-affiliated rheumatologists between July 2024 and January 2025. The questionnaire assessed knowledge, attitudes, clinical use, and educational preferences. A French version was developed and validated by the study steering committee. Responses were analyzed using descriptive statistics.ResultsA total of 105 rheumatologists from various Arab countries participated in the survey. The mean age of participants was 43.6 ± 11.7 years, and 61.9% were females. Most participants were adult rheumatologists (94.3%), primarily from Iraq (37.1%), Morocco (19%), and Algeria (16.2%). While 85.7% reported using biosimilars in practice, only 50.5% correctly identified the formal definition. Comfort with EMA/FDA-approved biosimilars was high (mean score 4.22/5), while concerns remained about switching in stable patients and among multiple biosimilars. The majority (80%) expressed interest in additional biosimilar education, particularly on regulatory approval, extrapolation, and safety.ConclusionArLAR rheumatologists show high uptake of biosimilars but moderate understanding of key regulatory and clinical concepts. Regionally adapted educational programs are needed to support evidence-based biosimilar use and improve confidence in clinical decision-making.

Background:The Mediterranean diet (MD) and low-fat diet (LFD) were well-known dietary interventions for cardiovascular disease prevention. However, there is an ongoing debate about the relative efficacy of improving cardiovascular (CV) risk factors and clinical outcomes between the 2. This systematic review aims to evaluate and summarize findings from randomized controlled trials (RCTs) that directly compare the MD and LFD concerning CV risk factors and clinical outcomes.Methods:Per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive literature search was conducted across PubMed, Google Scholar, SCOPUS, Science Direct, and RCTs that compared MD and LFD in adults, and reported data on CV risk factors or clinical outcomes were included.Results:Our systematic review includes 11 RCTs with 5942 participants. MD significantly reduced the formation of procoagulant and prothrombotic microvesicles. Studies have also reported that MD has resulted in greater reductions in total cholesterol, cholesterol-high-density lipoproteins ratios, insulin levels, blood glucose levels, leukocyte count, and body mass index compared to LFD.Conclusion:MD demonstrates superior efficacy over LFD in improving CV risk factors and outcomes. These findings could support the preferential recommendation of MD over LFD for the secondary prevention of cardiovascular diseases. Further research should explore the long-term adherence and implementation of these dietary interventions in diverse populations.