Osteoarthritis: New Insights. Part 2: Treatment Approaches

Abstract

Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors, such as genetics, diet, estrogen use, and bone density, and local biomechanical factors, such as muscle weakness, obesity, and joint laxity. These risk factors are particularly important in the weight-bearing joints, and modifying them may help prevent osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 2 of a two-part summary of a National Institutes of Health conference that brought together experts in osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 2 focuses on treatment approaches; evidence for the efficacy of commonly used oral therapies is reviewed and information on alternative therapies, including nutriceuticals and acupuncture, is presented. Biomechanical interventions, such as exercise and bracing, and behavioral interventions directed toward enhancing self-management are reviewed. Current surgical approaches are described and probable future biotechnology-oriented approaches to treatment are suggested.

Valgus Bracing for Knee Osteoarthritis: A Meta‐Analysis of Randomized Trials

“…Importantly, although potential treatments available for medial knee osteoarthritis are increasing, only a limited number have proven to be effective (7). Despite previous reviews that are generally supportive of valgus bracing and highlight their relatively low cost and associated risks (11,(52)(53)(54), the rates of valgus brace prescription are very low (23)(24)(25).…”

Physical activity levels among the general US adult population and in adults with and without arthritis

“…Despite the fact that multiple clinical trials have shown that PA and exercise are beneficial for people with arthritis, almost one-third of persons with arthritis are completely inactive, and only one-quarter get enough PA to comply with national PA recommendations (13)(14)(15)(16)). Yet, it is possible for persons with arthritis to meet the national recommendations by engaging in moderate types of joint friendly PA such as walking, gardening, bicycling, and swimming.…”

“…Because arthritis is the leading cause of disability, one benefit of increasing PA levels may be decreasing the development of arthritis-related disability (17). Evidence from randomized clinical trials suggests that PA, both aerobic and resistive exercise, benefits persons with knee osteoarthritis, contributing to modest improvements in disability, physical performance, and pain (13)(14)(15)(16).…”

Quantitative MRI of cartilage and bone: degenerative changes in osteoarthritis

“…Currently there exists no accepted medical treatment with structure or disease modification in OA (24)(25)(26)(27)(28)(29)(30)(31), despite the high and vastly increasing number of patients with a need to be treated. In this context, quantitative MRI can help to identify promising drug targets (by identifying tissue components that change first and are responsible for changes in other tissues) and, in particular, to monitor structural effects of drugs in order to prove their effectiveness.…”