Drug Slows Knee Osteoarthritis Progression

knee with arthritis

Nov. 12, 2012 — A drug used outside the U.S. to treat osteoporosis may not only lessen the everyday pain associated with knee osteoarthritis, but may even slow down the progression of osteoarthritis, researchers say.

The drug is called strontium ranelate.

In a three-year study of more than 1,300 people with knee osteoarthritis, digital X-rays revealed substantially less loss of cartilage in the joint space in those who took strontium ranelate every day compared with people who took a placebo daily.

In people with osteoarthritis, the cartilage in a joint wears away in some areas. The function of cartilage is to reduce friction in the joints and serve as a “shock absorber.” The wearing away of cartilage leads to pain and other symptoms.

Nearly one in 100 people have evidence of knee osteoarthritis on an X-ray. And nearly 19% of women and 14% of men age 45 and older have joint pain, stiffness, and other symptoms of knee osteoarthritis, according to a large 2007 study.

Study head Jean-Yves Reginster, MD, PhD, presented the findings today at the American College of Rheumatology (ACR) Annual Meeting in Washington, D.C. He is president and chair of the department of public health sciences at the University of Liège in Belgium.

What Is Strontium?

Strontium is a trace element found in seawater and soil. Its main dietary sources are:

  • Seafood
  • Whole milk
  • Wheat bran
  • Meat
  • Poultry
  • Root vegetables

In several European countries and Australia, a form of strontium, called Protelos (strontium ranelate), is available as a prescription drug for osteoporosis treatment.

Protelos is not approved in the U.S. But forms of the element, such as strontium citrate, are widely available as nutritional supplements in supermarkets, health food stores, and online.

But strontium supplements can’t just be substituted for Protelos, says ACR spokesman Stanley Cohen, MD, a rheumatologist at the University of Texas Southwestern Medical School in Dallas. They would have to be tested in another study.

Strontium in Perspective

Cohen notes that there are a variety of arthritis medications called disease-modifying anti-rheumatic drugs (DMARDs) that work by curbing the underlying processes that cause certain forms of inflammatory arthritis, including rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.

But finding a drug that can actually delay the progression of knee osteoarthritis is difficult, he says. Several large trials of drugs that looked promising in early research failed to pan out.

“That makes this study potentially very exciting,” he says.

But until the research has been reviewed by other doctors and published in a medical journal, it is too soon to draw firm conclusions, Cohen says.

With no approved treatment to delay the progression of the disease, current osteoarthritis treatments focus on improving disease symptoms through a combination of medication, physical therapy, and other non-pharmaceutical therapy.

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People With Osteoarthritis Benefit From Hospital-Based Exercise Programs

Main Category: Arthritis / Rheumatology
Also Included In: Sports Medicine / Fitness;  Pain / Anesthetics
Article Date: 13 Nov 2012 – 0:00 PST

People With Osteoarthritis Benefit From Hospital-Based Exercise Programs

A low-cost exercise program run by Hospital for Special Surgery in New York City has significantly improved pain, function and quality of life in participants with osteoarthritis, according to new research.
The study adds to the growing evidence that exercise is beneficial for osteoarthritis and shows that a hospital-based program can work. The study will be reported at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals (ACR/ARHP), to be held Nov. 9-14, in Washington D.C.
The new study showed that the weekly exercise programs significantly improved enjoyment of life and balance, and decreased pain and the severity and frequency of falls. “When participants were asked to report their level of pain severity, there were statistically significant reductions in pain from pre- to post-test. Pain is a huge factor in quality of life,” said Sandra Goldsmith, director of the Public and Patient Education Department at Hospital for Special Surgery. “If we can offer classes that help to reduce pain, that is a good thing.”
Roughly ten years ago, HSS launched its Osteoarthritis Wellness Initiative, which has grown to encompass both an educational component, including lectures and workshops, as well as exercise classes. In the study to be presented at the recent ACR/ARHP meeting, Special Surgery researchers evaluated the effectiveness of the exercise programs on 200 participants.
The classes, which met weekly throughout the year, included Tai Chi, yoga, mat and chair pilates, yoga-lates and dance fitness. Instructors who could tailor exercises for those with osteoarthritis and other musculoskeletal issues supervised the exercise programs. The researchers analyzed results from surveys that were administered before and after the exercise programs. The surveys included measures of self-reported pain, balance, falls and level of physical activity. An 11-point numeric pain intensity scale was used to quantify intensity of muscle or joint pain. The 10-point Brief Pain Inventory was used to measure pain interference on aspects of quality of life, including general activity, mood, walking ability, sleep, normal work (both outside the home and housework), and enjoyment of life.
In the sample of 200 participants, roughly 53% indicated that they experienced pain relief as a result of participating in the exercise programs. In fact, when researchers analyzed the subset of 66 participants who completed both pre and post surveys, a larger proportion, 62%, indicated they experienced pain relief after participating in the exercise programs. The level of pain intensity that participants experienced also significantly dropped from 4.5 to 2.7 in this group, where 0 was no pain and 10 was the worst pain imaginable. When researchers compared participants’ estimation of how much pain interfered with various aspects of an individual’s life, they identified a 54% improvement in general activity, mood, walking ability, sleep, normal work, and enjoyment of life.

“We asked participants to rate their balance, and we found a statistically significant increase in those who rated their balance as excellent, very good or good, from pre- to post-intervention, ” said Dana Friedman, MPH, outcomes manager in the HSS Public and Patient Education Department. Fewer respondents reported falling from pre- to post-test (14.5% vs. 13.1%), as well as sustaining injuries that required hospitalization (12.1% vs. 10.6%).

Linda Russell, M.D., a rheumatologist at HSS who is chair of the Public and Patient Education Advisory Committee, points out that the classes are low cost for patients and the fees cover the majority of costs associated with offering these types of programs, including salaries for the instructors. “We like to get all of our patients involved in exercise, and if we can help with a low-cost alternative to exercising in New York City, because gyms are expensive, then it is wonderful,” said Dr. Russell. “Patients benefit from supervised exercise programs with regard to their overall sense of well-being and pain due to their arthritis. We encourage other institutions to launch these types of program.”

“We’d like to be a role model for other hospitals, showing them that offering this type of program can help their patients reduce pain and improve quality of life,” said Ms. Goldsmith. “We are willing to discuss the details about how to start these programs.”

All exercise programs were run through the HSS Public and Patient Education Department, which includes the Greenberg Academy for Successful Aging, a collaborative program between the HSS Public and Patient Education Department and NewYork-Presbyterian Hospital’s Irving Sherwood Wright Center for the Aging.

Osteoarthritis is the leading cause of disability in the United States. According to the Centers for Disease Control and Prevention, an estimated 50 million U.S. adults, 22% of the population, suffered from osteoarthritis in 2009, compared with 46 million in 2003-2005. Arthritis affected the daily activities of 21 million adults in 2009. Body mass index influences the prevalence of arthritis; 29.6% of obese adults have arthritis.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.
Other Hospital for Special Surgery authors involved in the study include Linda Roberts, LCSW, Dana Sperber and Laura Robbins, DSW.
Hospital for Special Surgery
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Arthritis Patients’ Lives Improved By Complementary And Alternative Therapy

Main Category: Arthritis / Rheumatology
Also Included In: Complementary Medicine / Alternative Medicine
Article Date: 31 Oct 2012 – 3:00 PDT

Arthritis Patients’ Lives Improved By Complementary And Alternative Therapy
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Nearly a quarter of patients with rheumatoid arthritis and osteoarthritis used complementary and alternative therapy (CAT) to help manage their condition, according to a study in the November issue of the Journal of Clinical Nursing.
Researchers interviewed 250 patients aged between 20 and 90 years of age. More than two-thirds (67%) had rheumatoid arthritis and the remainder had osteoarthritis.
They found that 23% used CAT in addition to prescribed drugs and that just under two-thirds of those (64%) felt that the therapy was beneficial, reporting improvements in pain intensity, sleeping patterns and activity levels. “Our study underlines the importance of healthcare professionals being knowledgeable about the potential use of CAT when providing medical care to patients with arthritis” says lead author Professor Nada Alaaeddine, Head of the Regenerative and Inflammation Lab in the Faculty of Medicine, University of St Joseph, Beirut, Lebanon.
“Although CAT might have beneficial effects in rheumatoid arthritis and osteoarthritis, patients should be cautious about their use and should tell their healthcare providers that they are using them to make sure they don’t conflict with their existing treatment.”
Key findings of the survey included:

  • CAT users had an average age of 45 years, significantly younger than the average non CAT user, who was aged 57 years.
  • CAT use was higher in patients with osteoarthritis (29%) than rheumatoid arthritis (20%).
  • The most common CAT used was herbal therapy (83%), followed by exercise (22%), massage (12%), acupuncture (3%), yoga and meditation (3%) and dietary supplements (3%).
  • Just under a quarter of the patients using CAT (24%) sought medical care because of possible side effects, but they were not serious and were reversible. The most common side effects included skin problems (16%) and gastrointestinal problems (9%).
  • The majority did not tell their healthcare provider about their CAT use (59%).
  • CAT users were asked to rate the amount of pain they felt and the percentage who said that they experienced no pain rose from 12% to 43% after CAT use. The number who slept all night rose from 9% to 66%.
  • CAT users also reported an improvement in daily activities. The percentage who said that their pain did not limit them at all rose from 3% to 12% and the percentage who said they could do everything, but with pain, rose from 26% to 52%.

“CAT use is increasing and this study shows that it provided self-reported benefits for patient with rheumatoid arthritis and osteoarthritis” says Professor Alaaeddine.
“It is, however, important that patients discuss CAT use with their healthcare practitioner and that they are made aware of possible side effects, in particular the possible interactions between herbal and prescribed drugs.”

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.
“Use of complementary and alternative therapy among patients with rheumatoid arthritis and osteoarthritis.” Alaaeddine et al.Journal of Clinical Nursing. 21, pp3198-3204. (November 2012). doi: 10.1111/j.1365-2702.2012.04169.x
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Unnecessary Knee Arthroscopies Still Being Performed?

Main Category: Arthritis / Rheumatology
Also Included In: Bones / Orthopedics
Article Date: 01 Oct 2012 – 1:00 PDT

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Arthroscopy is still commonly being performed on people with osteoarthritis (OA) of the knee despite evidence against the effectiveness of the surgical procedure for this condition, according to research published in the October 1 issue of the Medical Journal of Australia.
Although the number of knee arthroscopies had declined overall, rates had remained steady in those with osteoarthritis in the 9 years to 30 June 2009, according to Dr Megan Bohensky from the Centre of Research Excellence in Patient Safety and coauthors, who studied usage patterns in Victorian hospitals.
According to the authors, research published 10 years ago and backed by subsequent studies questions the benefit of knee arthroscopy in patients with osteoarthritis.
“Because arthroscopic procedures can be associated with complications, it is important that they are used only when they are likely to have measurable positive outcomes”, the authors wrote.
“Given the uncertain evidence of effectiveness, general practitioners should encourage patients with OA of the knee who have no evidence of major mechanical derangement to try non-surgical treatments in the first instance”, they wrote.

In an accompanying editorial, Professor Rachelle Buchbinder, director of Monash Department of Clinical Epidemiology, Cabrini Health and Professor Ian Harris from the South Western Sydney Clinical School, University of New South Wales wrote that it was difficult to “shift the convictions of many surgeons”.

They wrote that in contrast to new drugs, promising new surgical interventions continued to be introduced into practice before their proper evaluation.

“The use of arthroscopy for knee osteoarthritis has been allowed to continue, exposing patients to an intervention that is at best ineffective, and at worst, harmful”, they wrote.

Article adapted by Medical News Today from original press release. Click ‘references’ tab above for source.
Visit our arthritis / rheumatology section for the latest news on this subject.
The Medical Journal of Australia is a publication of the Australian Medical Association.
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‘Unnecessary Knee Arthroscopies Still Being Performed?’

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