Microenvironmental response-based treatment of osteoarthritis is a highly effective and durable program: a review.

Osteoarthritis ( Agostini et al. in J Pers Med 14(8), 2024) is a major health concern causing disability in middle-aged and elderly populations, primarily characterized by degeneration and damage of articular cartilage. The pathological features of OA often overlap with normal aging processes, complicating clinical diagnosis. Studies have shown that OA progression is accompanied by dynamic changes in the internal microenvironment, making microenvironment-responsive diagnostic and therapeutic strategies a focus of research. This review provides a comprehensive overview of current pathological characteristics and microenvironmental factors associated with OA, including histopathological features, inflammatory microenvironment, extracellular matrix microenvironment, and epigenetic microenvironment, which involve complex multi-level interactions among cells, molecules, and signaling pathways. Furthermore, we systematically summarize current therapeutic approaches encompassing non-pharmacological therapies, pharmacological agents, herbal medicine, and surgical interventions, with particular emphasis on novel microenvironment-responsive therapeutic strategies, especially the cross-disciplinary applications of biomaterials in this field. This review aims to advance research on OA diagnosis, internal microenvironmental dynamics, and material-based microenvironment modulation, while offering new research perspectives for professionals in healthcare, biomaterials science, and clinical practice.