The American College of Rheumatology meeting, held in Atlanta, Georgia, November 7-11, 2010, provided some modest new advances in understanding osteoarthritis.
Osteoarthritis is characterized by the gradual wear and tear of articular cartilage, the cartilage that covers the ends of long bones. Osteoarthritis primarily affected weight-bearing regions such as the neck, lower back, hips, and knees.
Osteoarthritis is the most common form of arthritis, affecting more than 20 million Americans and is expected to increase in frequency as Baby Boomers continue to age.
The goal of treating osteoarthritis is to relieve pain 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” can provide clues as to why some people develop osteoarthritis more easily than others. So, in addition to cartilage trauma, 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 osteoarthritis could be identified and treated more aggressively.
2. Cymbalta (duloxetine), a drug already approved by the FDA for the treatment of major depressive disorder, fibromyalgia, and diabetic peripheral neuropathy, has been approved by the FDA for the treatment of chronic musculoskeletal pain, including pain resulting from osteoarthritis. and chronic low back pain. . The efficacy of Cymbalta for chronic low back pain and osteoarthritis was evaluated in four randomized, double-blind, placebo-controlled clinical trials. Cymbalta patients in these trials experienced significantly greater pain reduction compared to placebo.
3. Data were presented on naproxcinod, a unique non-steroidal anti-inflammatory drug. Naproxinod is the first cyclooxygenase inhibitor (CINOD) nitric oxide donor in development for the treatment of osteoarthritis. It was found to be comparable to naproxen in its ability to relieve hip osteoarthritis pain, while causing fewer adverse effects on blood pressure.
4. The popular “new kid on the block,” vitamin D, took a reputational blow. Vitamin D supplementation was unsuccessful in helping knee osteoarthritis patients overcome pain in a study presented by Tufts University.
5. The use of ultrasound to guide knee injections for the treatment of osteoarthritis led to a 42 percent reduction in pain, a doubling response rate to therapy, and a 15 percent reduction in cost for patients. patients, compared to conventional “feel” guided injections.
6. Pennsaid, a relatively new topical agent that combines the anti-inflammatory effects of diclofenac with the penetrating power of DMSO, presented some encouraging data on pain relief in knee osteoarthritis.
7. Another study showed that Lidoderm patches provide other possible options for knee osteoarthritis pain relief and are superior to placebo.
8. Researchers at the Rush School of Medicine in Chicago recently studied the gait of 16 adults who, through X-rays and reported symptoms, were diagnosed with osteoarthritis of the knees. The researchers found that special shoes can relieve knee pain and slow the progression of knee pain and arthritis.
9. A study from the Netherlands showed that knee distraction (using pins to open the knee joint) actually led to cartilage growth and improved symptoms, as well as avoiding the need for a knee replacement.
10. Two presentations on mesenchymal stem cells offered hope that, in the near future, the ability to regenerate cartilage to treat osteoarthritis is a possibility. The first was a talk by Dr. Nathan Wei, from the Arthritis Treatment Center in Maryland, who presented data on 22 patients treated with mesenchymal stem cells for knee osteoarthritis. At six months and one year after treatment with autologous stem cells (the patient’s own stem cells), patients showed improvements in both subjective and objective measures of cartilage growth. The second talk by Dr. Rocky Tuan from the University of Pittsburgh demonstrated that the transformation of adult mesenchymal stem cells into human articular cartilage was not only possible but relatively easy.