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OA Knee Pain Treatments Of The Near Future7th February 2019
Osteoarthritis (OA) is the most common form of arthritis in the UK, occurring when the cartilage cushioning the joints wears down.
Most commonly found in people over 50 years old or following an injury or other stress on the joints, OA is most often seen in the knees and can cause serious pain and debilitation to those who develop it.
Unfortunately, there is no cure for OA and most treatments focus on pain management or slowing the wearing down of the cartilage. In many cases, doctors will prescribe painkillers including acetaminophen or nonsteroidal anti-inflammatories such as aspirin, ibuprofen or naproxen to treat the pain and try to make mobilising easier for those afflicted with the disease.
Most sufferers of OA will also be given physical therapy exercises to complete. This has the intention of encouraging the joint to move despite the pain in order to avoid swelling or other complications.
Another recommendation for those with OA is to take a look at diet and exercise, as obesity can be a high-risk factor for developing OA by putting additional pressure on the joints.
When medication and physical therapy is still not enough, surgery to replace or repair the joint can be considered, however, it’s not the best course of action for everyone and should be thoroughly discussed with a doctor beforehand.
As OA affects so many people in the UK and overseas, research into different treatments is ongoing to try and find an effective method of pain reduction and possibly even a cure. If you would like to get involved in any clinical trials, you should speak to your GP who will be able to let you know whether there are any for which you might be eligible.
Earlier this year, a study commenced at University Hospital Southampton NHS Foundation Trust looking into whether patients’ blood could provide longer-lasting pain relief and better knee joint functions than traditional steroid-based medication.
In this study, a sample of the patients’ blood is spun in a centrifuge to separate the platelets - containing growth proteins which help heal injuries - from red blood cells and mixing this with hyaluronic acid. The hyaluronic acid is a substance similar to natural joint fluid and has been used in knee arthritis treatments for the past 10 years, so is a sensible addition to this trial.
Although this research is seeing some positive results, there are questions surrounding the effectiveness of hyaluronic acid in treating OA, with some critics claiming that it works as a placebo with regards to mobility and pain, rather than making any actual impact.
Unfortunately, the full results of this study are yet to be seen, so further research will need to be undertaken before a conclusion on the effectiveness of this treatment can be made.
Cartilage Cell Transplantation
In February 2018, autologous chondrocyte implantation (ACI) was approved for funding across the NHS. This treatment is designed for those with early OA of the knee or patients who have experienced some small cartilage damage.
ACI involves growing healthy cells in a laboratory from a sample of cartilage collected from the patients’ knee and returning them to the affected area. Once returned to the knee, the chondrocyte cells will attach to the bone within 24 hours and enable fresh cartilage to grow over the damaged area.
Research into this treatment has shown that factors such as age, gender, location and number of defects and any previous operations can affect the success rates of ACI, making it most appropriate for younger patients who haven’t already undergone knee surgery.
In successful patients, everyday use of the joint returned to normal around 3 months following the ACI procedure, and the patients could even play sports after 12 months.
The fact that ACI has been approved for NHS funding is a good indication that it’s a successful treatment strategy and rolling it out for further availability across the UK will hopefully see many people afflicted by OA living a far better quality of life.
Total Knee Replacement (TKR)
TKR is already an established treatment for OA and other types of arthritis which leads to a successful outcome for over 75% of patients.
That said, the longevity and stability of TKR is dependant on the accuracy of the surgery undertaken. A deviation of just 3 degrees can cause the implants to fail by placing abnormal stress on the joint. This is a particular issue when considering that most TKRs involve generalised cutting blocks to create the new knee, rather than implants which have been moulded on the specific shape of the patients’ own knee.
In a new study, TKR is taking place using ‘patient-specific’ technology to scan a patients’ knee and create a custom cutting block to recreate the natural knee as closely as possible.
This technology is also likely to reduce the cost of TKR by reducing the number of sterilised trays required during surgery and should cause less ‘mid flexion instability’ (whereby a patient feels unsteady on stairs or slopes following their TKR).
Those diagnosed with OA will no doubt be familiar with the recommended knee brace to attempt to reduce misalignment and pressure on the joint.
The Institute for Applied Health Research of Glasgow Caledonian University is leading the way in an experimental trial looking at whether 3D printing knee braces might provide a more effective method to reduce some comment complaints brace wearers come up with. These complaints include blisters, discomfort, poor fitting and bulkiness among others.
The hope is that by 3D printing knee braces, these will be more tailor-made to each individual, meaning that they should fit far better than standard braces.
The study will be taking place in Glasgow and will involve participants aged 40 - 70 years old of both genders in a 10 week long experiment. During this period, they will be asked to wear two different knee braces and to fill in questionnaires regarding comfort and to undergo gait analysis.
This should help to show 3D printed knee braces as a more sustainable and appropriate method of brace manufacturing, potentially changing the way in which we look at knee braces forever.
A potential cure?
Scientists in Canada have claimed to be honing in on a potential cure for OA by using experimental models including animal models and human tissue samples to zero in on a biomarker called microRNA-181a-5p, which is thought to cause the inflammation, cartilage destruction and collagen depletion suffered by those with OA.
In their studies, Locked Nucleic Acid-Antisense Oligonucleotides (LNA-ASO) was able to act as a blocker to microRNA-181a-5p, stopping further destruction of the cartilage.
As no treatment to actually stop or possibly cure OA currently exists, this is an incredibly exciting piece of research. Although the technology required to advance the biomarker blocker is still in its infancy, the research has taken an enormous leap forward, with the next steps involving starting safety studies to determine the appropriate blocker dosage for patients to ensure swift and safe delivery.
The team will also need to consider a method of injecting the blocker into patients, with the general consensus being that it will need to be injected directly into the knee or spinal joints in order to achieve maximum efficiency.