| Osteoarthritis (OA) is one of the most common | | | | treatments include: analgesics, |
| conditions leading to disability and impaired quality of | | | | non-steroidal-anti-inflammatory drugs (NSAIDS), |
| life in the Western world. | | | | topical agents ("rubs"), and joint injections with either |
| Ironically, while more effective disease-modifying | | | | glucocorticoids ("cortisone"), or hylauronic acid |
| therapies have been developed for rheumatoid | | | | lubricants. |
| arthritis, particularly within the last 10-15 years, | | | | Current research has been aimed at finding the |
| rheumatologists still treat osteoarthritis with | | | | triggers that cause inflammation to start and also to |
| symptomatic and supportive therapies. | | | | identify specific markers that might identify those |
| As a result, the inexorable progression of this disease | | | | patients who are at greatest risk for rapid |
| results in the performance of more than half a million | | | | progression of disease. These markers would also be |
| joint replacements annually in the United States. While | | | | useful in measuring improvement once newer drugs |
| joint replacement surgery has made gigantic strides, | | | | that can slow down disease progression in OA can |
| it is still a major surgical procedure. | | | | be discovered. |
| Risk factors for the development of OA include: | | | | However, all of these investigations are futile unless |
| genetic factors, obesity, joint injury, surgery, and the | | | | and until specific disease-modifying osteoarthritis |
| presence of associated metabolic disease. | | | | drugs (DMOADS) - drugs that slow down the rate of |
| It is clear from the research that OA is a disease | | | | cartilage loss- can be developed. |
| that involves not only the cartilage- the gristle that | | | | Drugs aimed at inhibiting cytokine and protease |
| caps the end of long bones and cushions the joint, | | | | function show some promise but it is still too early to |
| but also the synovium- the tissue lining the joint- as | | | | tell whether they will have the desired effect. |
| well as the bone that underlies cartilage. | | | | Examples of these drugs include: matrix |
| While genetic factors play a significant role in the | | | | metalloproteinase inhibitors, drugs that block |
| incidence of osteoarthritis, the damage that occurs is | | | | interleukin 1, bisphosphonates, calcitonin, as well as |
| a result of a complex interaction of inflammatory | | | | nutritional supplements such as glucosamine and |
| messengers. Among these are cytokines, | | | | chondroitin. |
| prostaglandins, nitric oxide, growth factors, and | | | | And it may not be enough to find drugs that simply |
| proteases. | | | | slow disease progression. |
| These substances, which are produced by | | | | The "holy grail" is still the treatment(s) that will rebuild |
| chondrocytes (cartilage cells) that are subjected to | | | | cartilage. The type of therapy that shows the |
| abnormal forces lead to a situation where there is | | | | greatest promise to date is the use of autologous |
| premature aging and destruction of cartilage | | | | stem cells. These are stem cells harvested from the |
| substance. | | | | patient and reintroduced into the affected joint along |
| The production of these inflammatory proteins also | | | | with a specific matrix to which the stem cells can |
| contributes to inflammation of the synovium and | | | | adhere and grow. |
| excessive amounts of bone growth. | | | | Early results look promising. For more information |
| Present therapies, as issued by guidelines proposed | | | | about stem cell treatment for osteoarthritis of the |
| by the Osteoarthritis Research Society International | | | | knee, contact the Arthritis and Osteoporosis Center |
| (OARSI), are clearly aimed at symptom relief. These | | | | of Maryland at (301) 694-5800. |