By Daniel Hernandez, MD, Global Healthy Living Foundation’s Medical Advocacy Liaison

Osteoarthritis (OA) is the most common form of arthritis worldwide, affecting an estimated 250 million people. OA is characterized by abnormalities in the tissues in the joint, leading to pain and loss of normal joint function. The tissues affected in the joint include the breakdown of cartilage—the smooth, rubbery connective tissue on the end of bones that cushions the joints, helping them move smoothly and easily. The bones in the joint also undergo changes, including enlargement with bony spurs (bony projections that develop along the edges of bones in the joints, also known as osteophytes) that can sometimes be noticed in the fingers as enlarged knuckles. In severe cases, there may be very little or no cartilage left, with the bones rubbing against one another. Tendons, ligaments, and muscles are also affected, and there can also be inflammation in the joint.

OA typically occurs later in life, usually after age 50, though it may start earlier, and can occur due to joint injury or be common within families. Women are more commonly affected than men. X-rays show just about everybody has some degree of osteoarthritis in one or more joints by age 70, most often in the hands, neck, spine, hips, and knees—and generally, the older one gets, the more susceptible they are to developing OA. The condition can get worse over time and there is no cure.

There is an evolving consensus among rheumatologists, orthopedists, and sports medicine physicians that osteoarthritis is not one single entity but a condition that includes inflammatory subsets, post-traumatic osteoarthritis, and congenital disease. The genetic influence on disease expression (obesity, heredity, joint overuse, deformity) and having other rheumatic diseases including gout and rheumatoid arthritis (RA) can increase the risk of developing early OA.

The current pharmacological treatment is to ease OA symptoms. Current research is looking to identify treatments that can modify disease activity.

Pain and OA

Experiencing pain isn’t a one size fits all term and this holds true when treating OA. There are many different types of pain OA patients experience based on how the OA manifests in the body.

For example, if you accidentally hit your thumb, it might get inflamed and cause pain. If you take an NSAID (nonsteroidal anti-inflammatory drug), that drug will help reduce the inflammation and reduce the pain.

Since OA affects different parts of your body in different ways, the pain that is being experienced can be from multiple sources (inflammation, nerve, etc.). Because of this OA is sometimes difficult to pinpoint and treat.

Current Treatments

Current OA treatments focus on treating symptoms (pain) with both non-pharmacological and pharmacological therapies. If these don’t work to alleviate symptoms, then surgery is seen as an option.

Common Non-Pharmacological Treatments

Physical Therapy and Exercise

The mainstays of OA treatment are weight loss (for knee and hip OA), exercise, and physical therapy, with a number of studies demonstrating good effects in managing OA pain and improving function with these approaches.

Examples include:

• Stretching
• Walking
• Tai Chi and Yoga
• Aquatic Exercise
• Bike Riding
• Weight Management

Common Pharmacological Treatments

Nonsteroidal anti-inflammatory drugs (NSAIDs) (learn more)
NSAIDs are the most commonly used drug treatments for OA pain and stiffness. NSAIDs include (but are not limited to) aspirin, ibuprofen, meloxicam, naproxen, and celecoxib.

Acetaminophen (Tylenol®)
Acetaminophen may be used for mild to moderate OA pain.

Duloxetine (Cymbalta®)
In 2010, the FDA approved the use of the oral medication duloxetine (Cymbalta®), a type of drug known as a selective SNRI (serotonin and norepinephrine reuptake inhibitor), for chronic musculoskeletal pain, including OA.

Glucocorticoids
Glucocorticoids are medicines used to reduce inflammation, but only for a short term period (approximately 4 weeks). They may also be called corticosteroids, or even “steroids” for short. If you have OA, you’re more likely to get a steroid injection directly into your painful joint, not steroids that are taken orally. OA affects particular, individual joints, not your whole body.

What’s Coming

Some drugs focus on modifying the pain of OA and others focus on modifying various ways OA affects the body. Researchers are looking at ways to modify both pain and disease activity. These are the different targets for treatment that are currently under investigation:

Disease-modifying osteoarthritis drugs (DMOADs)

DMOADs work to modulate or adjust the progression of OA. There are currently no FDA-approved DMOADs. Researchers are focusing on developing a DMOAD that can control pain, improve function and prevent or slow the structural changes to the joints. This is proving challenging because of the way in which OA affects a person.

Pain Modification – Identifying different treatment targets to eliminate pain.

• Anti-nerve growth factor

Structural modification – Modifying inflammation, and preserving or rebuilding cartilage and bone through various targets.

Inflammatory pathways

• TNF-alpha
• IL-1beta
• Inducible nitric oxide synthase inhibition
• Bradykinin receptor B2 antagonist

Cartilage catabolism and anabolism

• Wnt signaling pathway inhibitor
• Bone morphogenetic protein-7
• Fibroblast growth factor
• Cathepsin-K inhibitor
• Matrix metalloproteinase inhibitors
• ADAMTS
• Platelet-rich plasma
• Mitogen-activated protein kinase inhibitor

Bone remodeling

• Calcitonin
• Bisphosphonates
• Strontium

For more information about OA, download “A Patient’s Guide to Living with Osteoarthritis,” a publication of the nonprofit CreakyJoints. To view their library of resources visit: https://creakyjoints.org/patientguidelines/

 

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CreakyJoints is a digital community for millions of arthritis patients and caregivers worldwide who seek education, support, advocacy, and patient-centered research. We represent patients through our popular social media channels, our website www.CreakyJoints.org, and the 50-State Network, which includes more than 1,500 trained volunteer patient, caregiver and healthcare activists. 

As part of the Global Healthy Living Foundation, CreakyJoints also has a patient-reported outcomes registry called ArthritisPower® with more than 19,000 consented arthritis patients who track their disease while volunteering to participate in longitudinal and observational research. CreakyJoints also publishes the popular “Raising the Voice of Patients” series, which are downloadable patient-centered navigational tools for managing chronic illness. For more information and to become a member (for free), visit www.CreakyJoints.org. To participate in our patient-centered research program, visit www.ArthritisPower.org.