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An up-to-date on clinical prospects and management of osteoarthritis (OA)

OA

Goal of the Study?

In this research review article from the Annals of Medicine and Surgery 1 the authors’ purpose was to focus on the update of clinical prospects and management of osteoarthritis as well as future treatment possibilities.

 

Why are they doing this study? 

Osteoarthritis is a general term that incorporates several different joint diseases.  OA’s main effects include cartilage degradation, acute and chronic synovial inflammation, subchondral bone alteration, the presence of osteophytes and changes in synovial fluid.  The first studies on OA were conducted about 130 years ago and OA is now recognized as a multifactorial complex disorder.  OA was once believed to be a degenerative condition, but it is now known to have an infectious cause as well as a metabolic etiology.  The exact pathophysiology of OA remains unclear and both the pharmacological and non-pharmacological management of OA is continually evolving.

 

 

What was done?

The review began with an overview of OA’s inflammatory pathology focusing on the various cytokines, a group of secreted polypeptides that appears essential for the initiation of inflammation. Some cytokines are released in response to acute chronic inflammation and have anti-inflammatory properties and responses.   The majority of the review covered the pharmacological and non-pharmacological management of OA.  The more effective treatments include:

  • Exercise which is the recommended first-line treatment of OA.
  • Heat and Cold Therapy.  Heating decreases discomfort and increases the expression of Heat Shock Protein 70 which has both a relaxing effect and is involved in cartilage defence, reducing inflammation and preventing chondrocyte apoptosis.  The only reported benefit of cold therapy seems to be pain reduction.
  • Transcutaneous Electrical Nerve Stimulation (TENS), Low-level Laser Therapy, Massage, Acupuncture and Assistive Devices (canes, braces and insoles) can also improve mobility but seem to be more effective if used in conjunction with exercise.

The effectiveness of various pharmacological management tools were also discussed.  These included NSAIDs and other analgesics, topical agents, intra-articular therapy, Hyaluronic Acid, Anti-cytokine Therapy, Omega 3 fatty acids and Herbs and Ayurvedic formulations.  It appears that some ancient herbal Ayurvedic formulations, such as Triphala, Triphaghula, Balaraja and Dashamoola extracts, are re-emerging as an effective treatment option without the side effects of potentially risky medications.  Arthroscopic and replacement surgery are also discussed and use cases are provided. 

 

What did they find?

The researchers found a few gaps in the current pathogenesis of OA.  They also discussed some promising recent developments, especially ones that target the articular cartilage molecular process.  OA seems to present itself with overlapping endotypes and as such a single-targeted approach is not likely to be as successful as an integrated personalized approach.

 

Why do these findings matter?

Osteoarthritis (OA) severely restricts the everyday activities of senior citizens.  As the population ages, the frequency and prevalence of OA is expected to double over the next decade.  By age of 65, most people have radiographic proof of OA and by age 75 this increases to about 80% of the population.  OA is currently the most prevalent articular disease worldwide. Even though the exact pathophysiology of OA is unclear, there appear to be some effective non-pharmacological interventions.

 

At Dynamic Disc Designs, we work to help professionals explain the anatomy (in a dynamic and postural way) to help patients understand the positive things they can do for themselves to help reduce their pain.

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