Osteoarthritis (OA) is the most prevalent form of arthritis, affecting more than 30 million adults in the Unites States. The Arthritis Foundation is transforming the landscape of treatments and advancing OA science by gathering the top clinical research scientists and experts in the field through our OA Clinical Studies (OACS) program.
作为骨性关节炎项目基金会的主任，我非常高兴通过我们的OACS项目与OA研究和科学社区的领导人并肩工作，其中许多人最近参加了2020年美国风湿病学院(ACR)虚拟会议，分享最新的OA研究。许多关节炎基金会资助的研究人员也参加了今年的年会。
Here are some of the highlights from sessions I attended to learn the latest treatments and research that is underway in osteoarthritis.
Mechanisms for Pain Activation in OA and the Anti-NGF Treatments
A hot topic in OA is how to manage the pain OA without the use of opioids. One potential treatment being explored is the use of inhibitors for nerve growth-factor (NGF). Richard Loeser, MD, of University of North Carolina at Chapel Hill, is a current Arthritis Foundation funded awardee and moderated this session. The discussion looked at this important new class of pain therapy targeting NGF receptors in the joint for osteoarthritis pain.
Currently, the Federal Drug Administration (FDA) is evaluatingtanezumab, an NGF-inhibitor drug that works by interrupting the pain signal from reaching the spinal cord or brain. This could potentially become the first alternative to opioid analgesics for severe OA pain. This would be especially critical for patients who want to avoid becoming one of the 11.5 million Americans who are addicted to opioids to manage their pain.
Professor David Hunter, MD/PhD, of the University of Sydney in Australia, describes NGF inhibitors as “a novel agent, providing a unique pathway where a substantial portion of people who receive the drug get a considerable pain relief response” as well as being useful to “people who still have disabling pain despite exercise, weight loss, assistive devices and simple analgesics like anti-inflammatories.”
Camilla Svensson, PhD/MSc, from Karolinska Institute, believes that anti-NGF therapy can also have a significant role in autoimmune arthritis, with research showing NGF being detected in joints of autoimmune arthritis models as well.
But, this new class of drug has important safety considerations. Professor David Walsh, PhD/FRCP, of the University of Nottingham overviewed the mechanism of OA pain and reported at ACR that “Tanezumab is associated with reduced OA pain at 16 weeks and increased joint safety events through week 52.”
He also stated that “Tanezumab consistently reduced OA pain across clinical trials.”
Previously, Professor Walsh presented similarly at anOACS Forum Seriessession earlier this year, “Tanezumab and Similar Emerging Therapies”. During the forum he also commented about “Risk mitigation strategies in OA patients who do not receive pain relief.”Click here to watch morefrom this OACS forum program.
关节炎基金会医学科学顾问委员会成员法什·吉拉克博士对最新的研究发表了看法。“NGF抑制剂似乎在减轻OA疼痛方面具有极好的潜力。随着我们更多地了解NGF和神经控制的确切机制，不仅是疼痛，而且是整个关节健康，我们有望识别并大大减少导致快速进展性骨性关节炎的风险因素，特别是随着只针对NGF通路特定方面的新药物的开发。”
Metabolic and Crystal Arthropathies Poster
另一个会议强调了在评估膝关节骨性关节炎(OA)的关节损伤时使用成像的研究。来自波士顿大学医学院的Tuhina Neogi教授，医学博士/FRCPC分享了一项研究，比较了使用计算机断层扫描(CT)扫描和传统x光检查高危膝关节骨性关节炎的老年人关节内矿化。结果显示，CT扫描似乎比传统x线更敏感的发现问题的OA。这可能是一个有趣的，改进的成像方式来监测OA进展，以进一步探索和更好地治疗OA。
Dr. Neogi was a presenter and panelist in the October OACS Forum Series, “The Role of MRI in OA Clinical Research”.Watch the forum discussion here.
Epidemiology and Public Health Poster Session: OA, Osteoporosis, and Other Rheumatic Diseases
Physical therapy plays an important role in the treatment and management of osteoarthritis. One session discussed the role muscle strengthening plays in the management of OA.
“Weaker hip abductor strength was associated with new onset and worsening knee pain in females, but not in males,” said Cara Lewis, PhD, Associate Professor at Boston University School of Medicine. “The challenge is that addressing hip abductor weakness, by strengthening, doesn’t always change pain.”
Lewis says this may suggest that physical therapists should focus on their patients both gaining strength and using the gained strength during daily activities. This idea fits the “use it or lose it” philosophy. She reports the relation of abductor strength with knee pain appears to be substantially due to its association with quadriceps strength.
Hear more about the role of strength in OA by viewing our June OACS Forum Series recording, “Does Strong Muscle Matter in OA?”
Neuropathic Pain in Inflammatory Hand Osteoarthritis (OA) Lowers Quality of Life and May Require Another Approach Than Anti-inflammatory Treatment
Many people suffer from the pain of osteoarthritis (OA) in the hand, with little relief and minimal effective treatments. Several research results were shared in a session focused on treating neuropathic pain in inflammatory hand OA to improve quality of life. Researchers are exploring alternative approaches to treating OA hand pain besides anti-inflammatory treatments.
Leiden University Medical Center’s Dr. Coen van der Meulen, MSc shared research results, saying, “This study gives us new leads that investigate the nature of their pain. More detailed knowledge of the nature of pain in hand OA may in turn be used in future research to improve treatment options. We place a lot of importance on finding a better treatment for these symptoms, since we know how much quality of life they can cost.”
This research may help to open the doors to new and better treatments for hand OA.
Dr. Margreet Kloppenburg, Leiden University Medical Center (LUMC), one of the lead researchers for this study, also recently presented at the Foundation’s OACS Forum Series. She says their research “study indicates the diversity of pain subtypes seen in hand OA, including neuropathic-like pain.” These researchers believe their “study seems to indicate that different types of pain exist separately in patients with hand OA, and that they may require different types of treatment.”
Both Dr. Kloppenburg and Dr. van der Meulen think further studies are warranted to increase insight in the presence of pain subtypes in patients with hand OA and which treatments are most effective for the different subtypes of pain. Much more research needs to be done in this area.
Dr. Lotte van de Stadt, also part of this LUMC research study adds “We feel that these neuropathic pain-like symptoms warrant a great deal of attention in the upcoming years, so that we may better understand hand OA and ultimately move towards improving treatment for our patients.’
Many of these topics above were recently discussed as part of the ongoingOACS Forum Seriesand during the2020 OACS Online Conference计划在12月。关节炎基金会将继续召开讨论，通过这些论坛在2021年推进OA研究，以推进征服关节炎的使命。
-JASON KIM, DIRECTOR OF OSTEOARTHRITIS PROGRAMS