William C. Shiel, Jr., MD, FACP, FACR , Editor of the Arthritis Overview , Gives Perspectives Of Interest On Osteoarthritis From 2004 Annual Scientific Meeting Of The American College Of Rheumatology.
Below are perspectives on key reports presented at the national meeting of the American College of Rheumatology:
- Introduction
- Medications
- Running Does Not Affect Knees
- Water Exercise Helps
- Weather & Pain
- Acupuncture
- Weight Reduction
Osteoarthritis is a type of arthritis that is caused by breakdown of cartilage, with the eventual loss of the cartilage of the joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis. Among the over 100 different types of arthritis conditions, osteoarthritis is the most common and affects over 15 million people in the United States. Before age 45, osteoarthritis occurs more frequently in males. After age 55, it occurs more frequently in females. In the United States, all races appear to be equally affected. A higher incidence of osteoarthritis exists in the Japanese population, while South African blacks, East Indians, and southern Chinese have lower rates. Osteoarthritis usually affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees.
Hyaluronic acid injections into the knee joints of patients with osteoarthritis were reported as effective and safe in relieving pain.
Dr. Shiel's Perspective: While it is frankly not known how these compounds work, they can be effective in relieving pain in the knees of some patients with osteoarthritis. The medication is injected directly into the knees with a series of 3-5 weekly injections.
Botox injected into painful osteoarthritis knee joints was helpful in relieving pain.
Dr. Shiel's Perspective: Yes, you heard it right! This was a small study and will require much extensive research to confirm the significance of Botox in treating knee pain in osteoarthritis.
Etoricoxib (Arcoxia) was presented in 4 studies at the national meeting and shown to be safe and effective in treating gout, osteoarthritis, and ankylosing spondylitis.
Dr. Shiel's Perspective: Etoricoxib (Arcoxia) is a Cox-2 inhibitor that is used in Europe and elsewhere to reduce pain and inflammation of arthritis. This drug is somewhat related to Vioxx, another Cox-2 inhibitor that was withdrawn from the market by Merck because of heart attack and stroke side effects. Etoricoxib (Arcoxia) is awaiting approval for use in the U.S., and while its maker notes that it has been shown to be safe, I believe it will undergo serious scrutiny of longer term studies prior to approval for the U.S. market. The drug is clearly effective for the inflammation of arthritis.
Researchers from Stanford University reported a follow-up of runners that they had reported on in a famous study over a decade ago. The original study was reported by Dr. James Fries. The current authors continue to find now, as they had in the original study, that regular running does not lead to degenerative arthritis (osteoarthritis) in persons who start running with normal knee joints.
Dr. Shiel's Perspective: This study continues to reassure running enthusiasts. It is notable that there was no acceleration of osteoarthritis in regular runners over was is now an 18 year period! Also, the regular runners had less disability! This important study is ongoing. As the presenter of the current data commented to me personally, "The study will keep running for now!"
Aquatic exercise was again reported at this meeting to be helpful for patients with osteoarthritis.
Dr. Shiel's Perspective: This study highlights a reasonable exercise option that improves the quality of life of many patients with osteoarthritis. The Arthritis Foundation has long been an advocate of aquatic exercise programs.
Over a 30 month follow-up of patients with osteoarthritis of the knee joint, researchers from Boston found an association between an increase in humidity and increased pain and stiffness.
Dr. Shiel's Perspective: Well, anecdotally we hear this in the clinic frequently. The researchers also found an association of barometric pressure with pain in the joints, but not with stiffness.
Acupuncture was found to be helpful in relieving pain and improving function in osteoarthritis of the knee.
Dr. Shiel's Perspective: The researchers from the University of Maryland used traditional Chinese acupuncture successfully in a large number (190) of patients. These data confirm previous reports of the usefulness of acupuncture.
Researchers from John's Hopkins of Baltimore reported preliminary data that even small amounts of weight reduction (8% or approximately 17 pounds) in obese patients were associated with a 45% reduction in symptoms of osteoarthritis.
Dr. Shiel's Perspective: This report was exciting because it was also noted that the losses of weight seemed to improve symptoms even
For more, please see Osteoarthritis Index.
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