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Adults with mild to moderate knee osteoarthritis confirmed on imaging Inadequate relief from first-line conservative care: physical therapy, weight management, NSAIDs, activity modification No active joint infection No known allergy to hyaluronic acid products Not appropriate for or not yet ready for surgical evaluation Patients with end-stage knee OA (bone-on-bone on imaging) typically respond less well to viscosupplementation

Mass spectrometry can then be used to detect downstream metabolites and identify heavy atom (e.g., 2 H, 13 C, 15 N) enriched isotopologues 10

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