Research makes advances to treat osteoarthritis pain

Article from Arthritis Today Spring 2016 - No 169

For the 8.8 million people in the UK with osteoarthritis, research into new treatments to tackle osteoarthritis pain has the potential to dramatically improve quality of life. That’s why supporting innovative research in this area is one of our priorities, accounting for 25% of our research funding. 

We asked Dr Fiona Watt, consultant rheumatologist and senior clinical research fellow at our Centre for Osteoarthritis Pathogenesis at the Kennedy Institute of Rheumatology in Oxford, to share some of the latest developments:

“Most of the patients who walk through the door to my clinic want to know how I can help them with their pain. It’s undoubtedly the biggest issue facing people with osteoarthritis and a priority for us as researchers. 

I want to be able to treat people with osteoarthritis with drugs to reduce pain, but I also want to be able to prevent or slow down the process which drives the pain. Research over the last decade has shown us osteoarthritis isn't just caused by the joint surface wearing out.I want to be able to treat people with osteoarthritis with drugs to reduce pain, but I also want to be able to prevent or slow down the process which drives the pain.

There are also processes we can measure in the joints which actively drive the progression of the disease which should be drug-treatable, perhaps by a tablet or an injection into the joint. To offer the best outcomes, just like with heart disease, we need to understand how we can identify those at risk of painful osteoarthritis and use preventative treatments at an earlier stage, as well as developing drugs and improving surgical options to treat later stage disease. 

Working with at risk groups

To develop effective new drugs, understanding the mechanisms driving osteoarthritis is essential.

Within our centre there are several studies following people at high risk of developing osteoarthritis as a result of knee injury. By investigating changes taking place in their joints very early in this process we can try to understand why some people develop symptomatic osteoarthritis and some don't after a given injury. With this knowledge we aim to develop tests which will help us to predict an individual’s personal risk of arthritis after injury. 

In each study, by measuring substances in the joint, blood or urine we're able to understand more about disease processes we can target with new treatments in the future. Testing findings in this way is a critical stage in our research. 

Treating osteoarthritis with new or repurposed drugs

So what of new treatments? Our work suggests in the future there might be specific aspects of inflammation we can target to prevent damage or promote repair, but new treatments are some way off.

In the meantime, ‘repurposing’ – using an existing drug with well-established safety and tolerability to treat another condition – is an approach we’re exploring to help people with osteoarthritis. For example, we’re involved in two clinical trials, led by the University of Leeds, examining the ability of two established rheumatoid arthritis drugs, hydroxychloroquine and methotrexate, to improve pain in hand and knee osteoarthritis respectively. 

There are other developments in treating osteoarthritis pain which are at an advanced stage of testing in clinical trials. Our centre and others have shown that nerve growth factor (NGF) appears to be one of the key molecules contributing to osteoarthritis pain. Several pharmaceutical companies have developed drugs which block the NGF pathway, which look very promising in their ability to suppress the pain of osteoarthritis: some are injections under the skin and others are tablets.

We hope this might lead to a new class of pain-relieving drugs for osteoarthritis.

Positive action right now

Each of these areas of research has real potential to prevent and manage pain associated with osteoarthritis in the near future. But what do I say to people with osteoarthritis who understandably want to know ‘what can I do right now?’. Remember you have a recognised condition; you’re not just dealing with the inevitable signs of ageing.

Whether you’re dealing with a new diagnosis or living with advanced osteoarthritis, there's always something positive you can do. Remember you have a recognised condition; you’re not just dealing with the inevitable signs of ageing.

Osteoarthritis affects people differently. It doesn’t always progress and if you're experiencing pain now it doesn’t mean you’ll remain in pain.

Understanding as much as possible about your osteoarthritis is important and your healthcare professionals should be able to help with this. It’s also important to take positive action yourself to work out what aggravates or alleviates your pain. 

Absolutely the most important advice I give is about managing weight and taking regular exercise. This may seem boring compared to new drugs and treatments, but even a 5-kg weight loss can as much as halve lower limb pain caused by osteoarthritis – if only we had a drug which could do that!

Exercise is essential, whatever the stage and site of your osteoarthritis, both aerobic and joint-specific. Again your healthcare professionals should be able to advise you on the best and safest approach for you. 

Many people worry about using medication for their pain. But as doctors we worry about the physical and psychological effect on people of not using pain relief for regular moderate to severe pain. Speak to your GP about personalised pain management, whether you need simple pain relief advice or specialist input, for example through a pain clinic.

Pain is often undertreated, so getting structured advice on the right pain relief for you is crucial.”

Read our resources about living with osteoarthritis.

View article...