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A: Multiple pathways: GH receptor upregulation, nitric oxide system modulation, VEGF-promoted angiogenesis, and direct inflammatory cytokine interaction

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This inflammatory synovial fibroblast phenotype exacerbates cartilage degeneration, via the induction of matrix metalloproteases (MMPs) and aggrecanases (ADAMTS4/5), and sensitises the growth and activity of joint nociceptors [92,93,94]

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