From healio.com/news
Key takeaways:
- Osteoarthritis is a complicated condition requiring a multipronged management strategy.
- Physicians and patients should understand the stigma and misconceptions surrounding OA.
DESTIN, Fla. — Osteoarthritis, far from being “simply wear and tear,” demands a multifaceted management strategy, according to a speaker at the Congress of Clinical Rheumatology East.
“Rheumatologists tend to be discouraged when thinking about osteoarthritis,” said Amanda E. Nelson, MD, MSCR, RhMSUS, director of the Core Center for Clinical Research at the University of North Carolina at Chapel Hill.
“OA is not simply wear and tear or an unavoidable consequence of aging,” she said. “It is a complex multi-tissue imbalance between damage and repair, leading to molecular, anatomic and physiologic changes that can culminate in illness.”
Despite its prevalence, OA is often neglected clinically due to a lack of highly effective therapies, Nelson told Healio.
“However, there are many things we can do for our patients with OA, including educating them about what the condition is — and isn’t — as well as its likely time course and outcomes, and existing effective strategies for management,” she said.
Nelson outlined the currently accepted management approaches.
“Key components include education, physical activity and weight loss when appropriate, along with a variety of pharmacologic and non-pharmacologic ways to manage symptoms,” she said.
Patients can visit the Osteoarthritis Action Alliance website for education, according to Nelson.
“It takes 3 seconds,” she said.
Walking is the most highly recommended physical activity to improve OA symptoms and lose weight, according to Nelson.
“Tai chi gets pretty high scores, as well,” she said.
However, weight loss can present a challenge for some patients.
“We usually just tell them to lose weight, which is all we have time for,” Nelson said.
Although GLP-1 receptor agonists have made headlines across health care specialties, their exact impact on OA remains unclear until further data emerge, according to Nelson.
The data for other pharmacotherapeutic options in OA tend to be inconclusive, as well. Societies like the American College of Rheumatology and EULAR generally agree on topical or oral NSAIDs. Similarly, corticosteroid intraarticular injections are generally recommended, while hyaluronic acid intraarticular injections have shown minimal effects across meta-analyses and are largely not recommended.
To this point, rheumatologists should also understand what not to do for patients with OA, according to Nelson.
“Some options that are frequently used or discussed are not actually recommended, whether due to lack of benefit, evidence of harm, or lack of data,” she said. “Some of these strategies include platelet-rich plasma, stem cell injections, and most vitamin/nutritional supplements.”
However, there is other hope on the horizon, Nelson said.
“Drug repurposing and novel therapies are potential future options for management,” she said.
One such future option is LEVI-04 (Levicept), a non-opioid biologic protein that inhibits neurotrophin-3 for pain management, according to Nelson. She noted that phase 2 data have shown promising results in Western Ontario and McMaster Universities Osteoarthritis Index pain, with “promising safety signals.”
Until further data on this medication emerge, Nelson encouraged attendees to educate and assure their patients about the disease.
“Osteoarthritis is not just aging,” she said. “It is not their fault. This is a complex process. They didn’t do anything to deserve this.”
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