What’s New for Osteoarthritis Treatment?

The American College of Rheumatology meeting, held in Atlanta, Georgia, from November 7 through November 11, 2010 provided some new modest advances in the understanding of osteoarthritis.

Osteoarthritis is characterized by the gradual wearing away of articular cartilage the gristle that caps the ends of long bones. Osteoarthritis primarily affected weight-bearing regions such as the neck, low back, hips, and knees.

Osteoarthritis is the most common form of arthritis and affects more than 20 million Americans and is expected to increase in frequency as Baby Boomers continue to age.

The aim of treatment in osteoarthritis is to provide pain relief and improve function. However, the ultimate goal has always been to restore articular cartilage.

Some important highlights from this year’s meetings were:

1. The demonstration that genetic markers called “SNPs” may provide clues as to why some people develop osteoarthritis more readily than others. So, in addition to trauma to the cartilage, which is a known risk factor for the development of osteoarthritis, there also appears to be a genetic predilection for the disease. Perhaps, in the future, patients who are at higher risk for contracting osteoarthritis might be identified and treated more aggressively.

2. Cymbalta (duloxetine), a drug already approved by the FDA for treatment of major depressive disorder, fibromyalgia, and diabetic peripheral neuropathy, was approved by the FDA for treatment of chronic musculoskeletal pain, including pain resulting from osteoarthritis and chronic lower back pain. The efficacy of Cymbalta for chronic lower back pain and osteoarthritis were assessed in four double-blind, placebo-controlled, randomized clinical trials. Patients taking Cymbalta in these trials experienced significantly greater pain reduction compared with placebo.

3. Data on Naproxcinod, a unique non-steroidal anti-inflammatory drug was presented. Naproxinod is the first cyclooxygenase inhibiting nitric oxide donator (CINOD) in development for the treatment of osteoarthritis. It was found to be comparable to naproxen in its ability to relieve the pain of hip osteoarthritis, while causing fewer adverse effects on blood pressure.

4. The popular “new kid on the block”, vitamin D, suffered a blow to its reputation. Supplementation with vitamin D was unsuccessful in helping patients with osteoarthritis of the knee overcome pain in one study presented from Tufts University.

5. The use of ultrasound to guide knee injections for osteoarthritis treatment led to a 42 percent reduction in pain, a doubled response rate to therapy and a 15 percent reduction in cost to patients, compared with conventional injections guided by “feel.”

6. Pennsaid, a relatively new topical agent which combines the anti-inflammatory effects of diclofenac with the penetrating power of dmso cancer presented some encouraging data on pain relief for osteoarthritis of the knee.

7. Another study showed that Lidoderm patches provide another possible options for knee osteoarthritis pain relief and were superior to placebo.

8. Researchers from Rush Medical School in Chicago recently studied the gaits of 16 adults who, through x-rays and reported symptoms, were diagnosed with osteoarthritis of the knees. The researchers found that special shoes can ease knee pain and slow the progression of knee pain and arthritis.

9. A study from the Netherlands showed that distraction of the knee ( using pins to open the knee joint) actually led to cartilage growth and improvement of symptoms as well as avoidance of the need for knee replacement.

10. Two presentations on mesenchymal stem cells provided hope that in the near future, the ability to regenerate cartilage to treat osteoarthritis is a possibility. The first was a talk given by Dr. Nathan Wei, from the Arthritis Treatment Center in Maryland, who presented data on 22 patients treated with mesenchymal stem cells for osteoarthritis of the knee. At six months and at one year following treatment with autologous stem cells (a patient’s own stem cells), patients showed improvements in both subjective measures as well as objective measures of cartilage growth. The second talk given by Dr. Rocky Tuan from the University of Pittsburgh, demonstrated that transformation of adult mesenchymal stem cells into human articular cartilage was not only possible but relatively easy.

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