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National Institute of Arthritis and Musculoskeletal and Skin Diseases

(continued)

What Research Is Being Done on Osteoarthritis? continued...

Research has shown that losing extra weight can help people who already have osteoarthritis. Moreover, overweight or obese people who do not have osteoarthritis may reduce their risk of developing the disease by losing weight. A NIAMS-funded study is investigating the use of regular aerobic exercise in people with osteoarthritis of the knee to determine if standard guidelines for cardiovascular fitness may be useful for the treatment of early osteoarthritis as well.

Treatment

Researchers are studying the effectiveness of a variety of different types of treatment. These include:

Drugs to prevent joint damage: No treatment actually prevents osteoarthritis or reverses or blocks the disease process once it begins. Present treatments just relieve the symptoms.

Researchers are looking for drugs that would prevent, slow down, or reverse joint damage. Drugs under study include:

  • doxycycline, an antibiotic drug that may stop certain enzymes known to damage cartilage. A recent clinical trial found that doxycycline had a modest effect on slowing the rate at which the joint space narrows in the knee. The trial also found that people who were taking doxycycline experienced joint pain less often than those who were not.

  • the bisphosphonate drug risedronate: In a recent British study of several hundred people with mildto-moderate osteoarthritis of the knee, those treated with risedronate showed a clear trend toward reduced symptoms and improved joint structure.

More studies are needed for both drugs.

Estrogen: In studies of older women, scientists found a lower risk of osteoarthritis in those who had used oral estrogens for hormone replacement therapy. The researchers suspect that having low levels of estrogen could increase the risk of developing osteoarthritis.

However, the 15-year, NIH-funded Women’s Health Initiative found that taking estrogen plus progestin increased the risk of heart attack, stroke, blood clots, and breast cancer, while taking estrogen alone increased the risk of stroke and blot clots. The Food and Drug Administration recommends that hormone therapy be used at the lowest doses for the shortest duration needed to achieve treatment goals. Hormone therapy should always be used under a doctor’s care.

Several other research projects are underway. The goal of one is to determine if estrogen protects cartilage. Other projects are examining the effects on joint cartilage of a selective estrogen receptor molecule (SERM) called raloxifene, which is often used in place of estrogen to treat and prevent osteoporosis.

Complementary and alternative therapies:

  • acupuncture: One of the most popular alternative pain-relief methods is acupuncture, an ancient Chinese practice in which fine needles are inserted at specific points in the body. According to research funded by the National Center for Complementary and Alternative Medicine, acupuncture may help reduce pain and improve function for individuals with knee osteoarthritis when used as an adjunct to medication.

    One study underway compares the benefits of acupuncture with physical therapy to the benefits of physical therapy alone. The hope is that acupuncture will help relieve pain that makes exercise difficult and, therefore, will improve the effectiveness of traditional exercise physical therapy.

  • glucosamine and chondroitin sulfate: In recent years, the nutritional supplement pair glucosamine and chondroitin has shown some potential for reducing the pain of osteoarthritis, though no conclusive proof has emerged to date. Both of these nutrients are found in small quantities in food and are components of normal cartilage.

    The recently concluded Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which was cosponsored by the National Center for Complementary and Alternative Medicine and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, assessed the effectiveness and safety of these supplements, when taken together or separately.

    The trial found that the combination of glucosamine and chondroitin sulfate did not provide significant relief from osteoarthritis pain among all participants. However, a smaller subgroup of study participants with moderate-to-severe pain showed significant relief with the combined supplements.

    The 4-year trial was conducted at 16 sites across the United States. The results were published in the Feb. 23, 2006 edition of the New England Journal of Medicine.

  • other complementary and alternative therapies: Other research suggests that certain hyaluronic acid preparations; substances called anthraquinones; gelatin-related substances; and electrical stimulation may have a beneficial effect on cartilage growth and repair. Although these agents have shown varying degrees of promise in basic and clinical studies, additional trials are needed.

  • vitamins D, C, E, and beta carotene: The progression of osteoarthritis may be slower in people who take higher levels of vitamin D, C, E, or beta carotene. NIAMS is sponsoring a clinical trial on use of Vitamin D to treat osteoarthritis. More studies are needed to confirm these reports.

  • green tea: Many studies have shown that green tea possesses anti-inflammatory properties. One recent study showed that mice predisposed to a condition similar to human osteoarthritis had mild arthritis and little evidence of cartilage damage and bone erosion when green tea polyphenols were added to their drinking water. Another study showed that when added to human cartilage cell cultures, the active ingredients in green tea inhibited chemicals and enzymes that lead to cartilage damage and breakdown. Further studies are looking at the effects of green tea compounds on human cartilage.

  • prolotherapy: This is a popular, growing, and unregulated therapy for chronic musculoskeletal pain in which an irritant solution is injected into painful ligaments and adjacent joint spaces. However, no rigorous, scientifically valid clinical trials have proven the therapy’s action or usefulness. A clinical trial sponsored by the National Center for Complementary and Alternative Medicine is studying prolotherapy’s effectiveness for the pain of knee osteoarthritis. It is also using animals to assess the healing response after prolotherapy.

WebMD Public Information from the U.S. National Institutes of Health

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