Description
Osteoarthritis, the most common form of arthritis, is a degenerative joint disorder characterized by the gradual deterioration of joint cartilage and the underlying bone. It often affects weight-bearing joints such as the knees, hips, and hands, leading to pain, stiffness, and reduced joint mobility. Risk factors include aging, joint overuse, and genetic predisposition. While there is no cure, management involves pain relief through medications, physical therapy, and lifestyle modifications such as weight management and exercise. In severe cases, surgical interventions like joint replacement may be considered. Osteoarthritis poses a significant global health burden, underscoring the importance of early diagnosis and comprehensive management strategies to improve the quality of life for those affected.
Summary Listen
- Osteoarthritis (OA) affects a significant portion of the population, particularly those over 60, with prevalence rates varying between countries. While surgery remains a primary treatment option, patient acceptance is often limited due to mobility and mortality concerns associated with knee replacement. Understanding the pathobiology of OA, which involves a combination of degeneration, inflammation, and cytokine activity leading to cartilage destruction, is crucial for developing effective pharmacological interventions.
- Many commonly used drugs, like chondroitin, glucosamine, vitamin D, and opioids, have limited effectiveness in treating OA. However, pain medicines, both oral and topical, and intraarticular glucocorticoid injections, particularly when guided by ultrasound or CT scans, can be beneficial for knee osteoarthritis. In contrast, therapies such as stem cell injections, platelet-rich plasma, prolotherapy, and intraarticular botulinum toxin have not shown strong evidence of effectiveness.
- A dual serotonin and norepinephrine reuptake inhibitor, dosed at 30 mg per day, has shown promise in treating knee OA due to its analgesic action. However, careful monitoring is essential due to potential side effects. Academic guidelines, such as those from the American College of Rheumatology, emphasize the importance of physical therapy measures like exercise, weight loss, tai chi, and bracing, while acknowledging their limited effect size.
- Pharmacological approaches such as visosupplementation, glucosamine, hydroxychloroquine, methotrexate, and stem cell injections are not recommended for knee OA. Intraarticular hyaluronic acid shows some effectiveness in the knee and hip. Intraarticular steroids can be effective in managing inflammatory OA characterized by swelling, pain, and synovial fluid presence.
- Emerging therapies target bone, inflammatory cytokines, pain, and cartilage metabolism. These include NGF inhibitors, BMPL (TGF super family), fibroblast growth factor R3 activating agents, and MAP kinase inhibitors. Tannins map and recombinant anti-nerve growth factors are also being explored in early trials. Turmeric, though touted as an anti-inflammatory agent, has limited evidence of effectiveness.
- In summary, OA management requires individualized approaches. No drug has been approved to modify the course of the disease, and many commonly used treatments lack strong evidence of efficacy. Current effective interventions primarily focus on symptom management through pain relief and joint protection, while emerging therapies remain in early stages of development.
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About the Speakers
Dr. Shanmuganandan Krishnan
Professor SBMCH, Consultant Rheumatology, Apollo Hospitals, Chennai
Financial Disclosure
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