Arthritis Treatment: What's on the Horizon for Osteoarthritis Treatment?

Arthritis Treatment: What's on the Horizon for Osteoarthritis Treatment?

Osteoarthritis is the most common form of arthritis, affecting more than 30 million Americans. It is a disease of the articular hyaline cartilage that covers the ends of long bones. The purpose of hyaline cartilage is to cushion and absorb the impact of both direct tension and shear forces applied to the joint.

Osteoarthritis mainly affects high-impact joints such as the hips, knees, low back and neck. However, it can also involve the shoulder, ankle, base of thumb, and base of big toe.

Despite rheumatology's emphasis on newer therapies for diseases such as rheumatoid arthritis, relatively little has been done to address osteoarthritis. This is unfortunate as osteoarthritis (OA) is a significant cause of pain, reduced mobility, reduced productivity and reduced quality of life.

There is a gap between symptomatic therapies consisting of rest, physical therapy, analgesics, nonsteroidal anti-inflammatory drugs (NSAIDS), glucocorticoid (“cortisone”) injections, and viscosity supplements until the patient requires joint replacement.

I will discuss some of the “avant-garde” therapies being evaluated for the treatment of OA.

The first treatment is the use of stem cells. Stem cells are empty slate cells, cells that can be coaxed to differentiate into any type of tissue cell. The focus was on the use of adult mesenchymal stem cells. Studies have shown that when these cells are introduced into OA joints, they are incorporated into the articular cartilage of the affected joint. While most research has been demonstrated in animal models, there have been small studies and several anecdotal reports suggesting similar results in humans.

The second type of treatment that has been studied is the use of anti-cytokine medications. Some believe that OA is a systemic disease that requires systemic therapies.

Cytokines, which are protein messengers, play a crucial role in the generation and spread of inflammation. A cytokine that may play a role in the chronic inflammation seen in OA is interleukin-1. Attempts to block the effects of this cytokine have been studied with mixed results. When given systemically, performance was not much better than placebo. When injected as an injection into a joint, mixed results have been achieved.

Another material that has been studied is botulinum toxin (Botox). It appears to have positive effects on pain and inflammation. It has been used for OA of the knee as well as plantar fasciitis.

Other therapies that have been studied include platelet-rich plasma (PRP), insulin-like growth factor, and bone morphogenic protein. The results are controversial.

Inspired by Nathan Wei