Osteoarthritis a very common form of arthritis leads to the breakdown of cartilage, causing inflammation of the synovial membrane that surrounds it. Pain, reduced mobility and inflammation are the most common symptoms of this pathology. However, apart from pain management, there appear to be no effective long-term treatments. However, some new avenues are currently being explored.
Osteoarthritis is usually found in the joints of the hands, knees, hips, and spine and usually leads to a loss of cartilage. The mechanisms are poorly understood, but age is a major risk factor, with 65% of people over 65 affected by the disease.
What are the current treatment options for osteoarthritis?
Treatments are mostly aimed at controlling the symptoms. In fact, the aim of most current treatments is to relieve the symptoms of the disease without curing it. NSAIDs, paracetamol, opioids, and sometimes local corticosteroid injections are the best alternatives for pain management when these drugs are tolerated by the patient.
There are supplements such as chondroitin sulfate that can be combined with glucosamine to stimulate cartilage production, but these treatments are not a boon either.
Other potential candidates such as monoclonal antibodies against NGF (nerve growth factor) appear to be effective against pain. NGF, a nerve growth factor, is a pain-signaling protein produced by damaged tissue. It reaches high concentrations in joints with osteoarthritis. Unfortunately, harmful effects on the joint have been reported.
According to the FDA (Food and Drug Administration), this treatment offers no added value compared to the usual painkillers.
Hyaluronic acid injections, which consist of injecting a viscous product similar in composition to synovial fluid are still controversial. Some however swear that they reduce pain and help prevent osteoarthritis from worsening.
Ultimately, it seems that there is currently no fundamental treatment that can cure the disease.
New treatments for osteoarthritis under development
As inflammation seems to be involved in cartilage degradation processes, different anti-inflammatory molecules are being evaluated. So are new treatments to stimulate the production of cartilage by chondrocytes (cells that produce cartilage).
Fat stem cells (autologous ASCs) are also injected into the diseased joint to rebuild cartilage. These cells have a high capacity for differentiation and immunomodulation. The European Adipoa project is launching clinical trials in this area. The first published results are encouraging as the administration of these stem cells to joints reduced osteoarthritis in an experimental rabbit model and promoted cartilage repair. In humans, the initial phases of this study showed that the treatment produces a strong anti-inflammatory response.
At present, there are still no effective treatments for osteoarthritis. Only prevention can combat this pathology by avoiding risk factors as much as possible (obesity, diabetes, sedentary lifestyle). In short, a healthy diet and physical activity are still the best medicines.
Hermann, W., Lambova, S., & Muller-Ladner, U. (2018). Current Treatment Options for Osteoarthritis. Frontiers in Arthritis, 14(2), 108-116. doi:10.2174/1573397113666170829155149