Scientists Find an Unexpected Way To Fight Knee Arthritis

From scitechdaily.com

A long-term analysis of a randomized Russian trial suggests that low-dose radiation therapy could influence the course of early knee osteoarthritis. Among 292 participants, those who received radiation alongside medication experienced more lasting symptom relief and less joint deterioration than those taking medication alone. Nearly 12 years of health records also linked the treatment to less disability.

The strongest apparent benefits emerged in patients with grade 2 osteoarthritis, whose disease was established but not yet advanced. The findings are being presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting, but larger trials are needed to determine whether radiation truly changes how the disease progresses.

“The most compelling part of this study is how the outcomes fit together,” said Bobby (Nagendra) Koneru, MD, FASTRO, a study author and radiation oncologist at Loyola University in Maywood, Illinois. “Patients experienced sustained improvement in pain and function; MRI showed less joint deterioration, and years later, we saw less disability and, in patients with grade 2 disease, fewer knee replacements. Together, these findings raise the possibility that treatment may influence the longer course of osteoarthritis. That prospect makes it important to confirm in a larger multicentre study whether these findings represent a disease-modifying effect.”

Knee osteoarthritis affects an estimated 365 million people worldwide, making it a major cause of chronic pain and disability. The condition gradually damages cartilage and other joint tissues, leading to stiffness, reduced mobility, and, in severe cases, the need for knee replacement surgery.  Credit: Shutterstock

Why Radiation Is Being Studied For Osteoarthritis

Knee osteoarthritis involves the breakdown of cartilage and other joint tissues, causing pain and limiting movement. Inflammation can help drive that damage. Once cartilage or bone becomes permanently damaged, some patients eventually need a knee replacement.

Exercise, weight management, medications, and injections are commonly used to manage symptoms. They can make movement easier and reduce pain, but most do not reliably prevent further structural damage. That gap has prompted interest in treatments that might protect the joint as well as make it feel better.

Low-dose radiation has been used for decades in parts of Europe to relieve osteoarthritis pain and treat other noncancerous inflammatory conditions, and its use is increasing in the United States. It delivers a small fraction of the radiation used in cancer treatment, with the aim of reducing inflammation.

“Radiation therapy works differently at very low doses,” Dr. Koneru said. “In cancer treatment, we use much higher doses to kill cancer cells or keep them from growing. At the doses used for osteoarthritis, the goal is to reduce inflammation inside the joint.”

Testing Treatment Before Advanced Joint Damage

Previous research showed that low-dose radiation could improve short-term pain and physical function in mild-to-moderate knee osteoarthritis. This analysis examined a broader question: whether those improvements coincided with better joint structure and fewer serious consequences years later.

The trial enrolled people with symptomatic knee osteoarthritis classified as Kellgren-Lawrence grade 0, 1, or 2. These grades range from no definite osteoarthritis visible on X-rays to definite bone spurs and possible early narrowing of the joint space. Patients with grade 0 had evidence of osteoarthritis on MRI. Those with more advanced grade 3 or 4 disease were excluded.

Participants were relatively young, with a median age of 38. At a single Russian institution, they were randomly assigned to glucosamine and chondroitin alone or the same medications plus radiation therapy.

The radiation group received a total dose of 4.5 Gy across 10 treatments. An orthovoltage machine delivered the treatment using low-energy X-rays.

Pain Relief Matched By Less Joint Deterioration

Both groups initially reported less pain, but sustained relief occurred only in the radiation group. Those patients also experienced significantly greater and longer-lasting improvements in physical function and quality of life.

MRI scans followed joint changes for three years. At 12 months, imaging scores showed slight improvement in patients who received radiation, while the medication-only group showed worsening. The significant difference between the groups persisted throughout the imaging follow-up.

Researchers then reviewed regional health records over a median of 11.9 years, looking for knee replacements and government-certified disability attributed to knee osteoarthritis. Across the study population, radiation was associated with a 67% lower adjusted hazard of disability, a statistically significant finding.

Dr. Koneru noted that disability certification provided an independently assessed measure of the disease’s consequences. Together with symptom reports and MRI scans, it offered another way to evaluate whether the early benefits translated into better outcomes later.

Grade 2 Osteoarthritis Showed The Strongest Signal

Among the 78 patients with grade 2 disease, disability developed in 31% of those treated with radiation, compared with 61% of those receiving medication alone. This subgroup had the largest absolute reduction in disability. Knee replacement was also less common among those who received radiation, occurring in 14% of patients compared with 36% of those taking medication alone.

“Grade 2 disease may represent a window where osteoarthritis is established but extensive joint damage has not yet occurred,” Dr. Koneru said. “The combination of less disability and fewer knee replacements in these patients is particularly encouraging. It suggests an opportunity to study whether treating inflammation earlier can change the longer course of the disease.”

The findings make grade 2 osteoarthritis a promising focus for further research. However, the subgroup analysis and long-term outcomes were exploratory and need confirmation in a trial designed specifically to test them. The difference in knee replacement rates also did not reach statistical significance across the full study population.

What Still Needs To Be Confirmed

The study had limitations in both treatment blinding and follow-up. Participants knew which treatment they received, as the control group received medication alone rather than simulated radiation. MRI readers were blinded to treatment assignment, but incomplete follow-up scans limited the imaging data available for analysis.

The study’s single-institution setting also limits how broadly its results can be applied. Differences in health care delivery and access to knee replacement in Russia could affect the long-term outcomes observed elsewhere.

Researchers reported no immediate reactions to radiation and no cancers in the treated area during follow-up. Still, those observations cannot establish long-term safety: the study was not designed to measure uncommon effects that emerge years later or cancer risk over a lifetime, especially among younger patients. Larger studies that follow patients over time will need to examine these risks and determine how long the treatment’s benefits last.

Dr. Koneru said the next step should be a multicentre randomized trial focused on grade 2 disease, with simulated radiation as the control. Defining imaging measures and long-term clinical outcomes in advance would help establish whether the treatment can preserve joint health as well as relieve symptoms.

Looking Beyond Pain Relief

“For osteoarthritis, we have treatments that can help patients feel better, but much less evidence that they can change what is happening inside the joint. What makes these findings interesting is that the patient-reported improvement was accompanied by a measurable difference on MRI,” said Gopal K. Bajaj, MD, MBA, FASTRO, co-chair of ASTRO’s Functional Radiation Medicine Task Force and a radiation oncologist at Inova Schar Cancer Institute in Fairfax, Virginia.

“That moves the question beyond pain relief alone. The long-term disability data add another reason to test whether low-dose radiation can affect the course of early osteoarthritis in a larger, rigorously controlled trial.”

https://scitechdaily.com/scientists-find-an-unexpected-way-to-fight-knee-arthritis/

Nearly 10,000 patients reveal what works best for knee arthritis pain relief

From sciencedaily.com

A major analysis of 139 clinical trials involving nearly 10,000 people suggests that some of the simplest treatments may work best for knee osteoarthritis. Knee braces ranked highest overall for reducing pain, stiffness, and mobility problems, while water-based therapy was especially effective for pain and regular exercise consistently improved both pain and physical function. More high-tech approaches, including ultrasound, generally performed worse.

Knee braces, water therapy, and exercise may be among the most effective drug-free options for people with knee osteoarthritis, according to a large analysis published in the open-access journal PLOS One. The research was led by Yuan Luo of the First People's Hospital of Neijiang, China.

Knee osteoarthritis (KOA) is a widespread joint condition that affects millions of older adults. It can cause persistent pain, stiffness, and difficulty moving the knee, sometimes making everyday activities much harder.

Many patients are treated with anti-inflammatory medications, but these drugs can carry gastrointestinal and cardiovascular risks. That has increased interest in treatments that can relieve symptoms without relying on medication.

An analysis of 139 clinical trials found that knee braces, water-based therapy, and exercise were among the most effective drug-free treatments for knee osteoarthritis. Knee braces ranked particularly well, while ultrasound was consistently one of the least effective options. Credit: Shutterstock

Researchers Compare 12 Knee Osteoarthritis Treatments

To determine which non-drug therapies appear to work best, the researchers analysed evidence from 139 clinical trials involving nearly 10,000 people.

The studies evaluated 12 different approaches, including laser therapy, electrical stimulation, knee braces, insoles, kinesiology tape, water-based therapy, exercise, and ultrasound.

Rather than examining each treatment separately, the team used a network meta-analysis. This method allows researchers to compare multiple therapies across many different trials and estimate how each one performs relative to the others.

Knee Braces Perform Particularly Well

Knee braces ranked highly across several important measures. They were associated with reductions in pain and stiffness as well as improvements in physical function.

Hydrotherapy, which involves exercises or treatments performed in warm water, was especially effective for reducing pain. Regular exercise also produced consistent benefits, helping improve both pain and physical function.

Some more technologically advanced treatments also showed promise. High-intensity laser therapy and shock wave therapy produced benefits in certain areas.

Ultrasound, however, repeatedly ranked near the bottom of the treatment comparisons.

Simple Treatments May Have an Advantage

The findings suggest that relatively simple and accessible therapies may be among the strongest options for managing knee osteoarthritis without medication.

The researchers caution that the rankings are not definitive. The 139 studies differed in how they were designed; some involved relatively small groups of participants, and treatment durations varied considerably. Those differences can make it harder to precisely determine which therapy is truly best.

Even with those limitations, the authors concluded that physical therapies appear promising for KOA and could provide useful alternatives to anti-inflammatory medications.

Future research will need to investigate whether combining treatments produces even better results. Researchers also want to determine which approaches provide the greatest benefits relative to their cost.

The authors add: "Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis. They reduce pain and improve mobility without the gastrointestinal or cardiovascular risks linked to common pain medications. Patients and clinicians should prioritize these evidence-based options."

"Our analysis of nearly 10,000 patients reveals that simple, accessible therapies like knee bracing and water-based exercise outperform high-tech options like ultrasound. This could reshape clinical guidelines to focus on safer, lower-cost interventions."

Journal Reference:

1. Xiao Chen, Yuanhe Fan, Hongliang Tu, Yuan Luo. Clinical efficacy of different therapeutic options for knee osteoarthritis: A network meta-analysis based on randomized clinical trials. PLOS One, 2025; 20 (6): e0324864 DOI: 10.1371/journal.pone.0324864

https://www.sciencedaily.com/releases/2026/09/260913082208.htm

One injection could keep osteoarthritis drugs working for weeks

From sciencedaily.com

Scientists have created an injectable gel that can remain inside arthritic joints for weeks, slowly releasing medication while also improving lubrication. The approach could make it easier to deliver disease-modifying drugs directly where they are needed while limiting exposure elsewhere in the body. 

Scientists at the University at Buffalo have developed an injectable hydrogel designed to keep osteoarthritis treatments inside the joint for much longer than conventional injections.

After a single minimally invasive injection, the material changes from a liquid into a smooth, lubricating semisolid depot at body temperature. Once in place, it can remain in the joint for several weeks while gradually releasing drug-loaded nanocarriers.

A new injectable gel could turn one shot into weeks of targeted osteoarthritis treatment while helping lubricate damaged joints. Credit: Shutterstock

A Major Challenge in Osteoarthritis Treatment

Osteoarthritis (OA) is one of the world's leading causes of chronic pain and disability. Common treatments delivered directly into joints, including analgesics, corticosteroids, and viscosupplements, can ease symptoms, but their effects are often short-lived, and they do not consistently slow the progression of the disease.

One of the biggest obstacles is that small molecule drugs and biologics can be cleared quickly from synovial fluid. Researchers also face challenges when trying to deliver hydrophobic drugs at concentrations high enough to be effective without increasing exposure throughout the rest of the body.

The University at Buffalo hydrogel platform was designed to address both problems by keeping therapeutic compounds concentrated in the joint and releasing them gradually over time.

A Drug Depot That Forms Inside the Joint

The injectable formulation begins as a liquid, allowing it to be delivered with a minimally invasive procedure. At body temperature, it rapidly becomes a lubricious semisolid material that acts as a local drug reservoir.

The platform combines a biocompatible polymer matrix with drug-loaded nanocarriers. These nanocarriers are designed to carry high amounts of poorly soluble therapeutic compounds, which are otherwise difficult to deliver in an aqueous environment.

The system also uses materials with prior regulatory acceptance, a feature intended to make eventual clinical translation more practical.

Once inside the joint, therapeutic compounds are released through diffusion and gradual relaxation of the hydrogel matrix. This process provides controlled local exposure over multiple weeks rather than allowing the medication to disappear rapidly from the joint.

Researchers have validated the approach using a SIRT6 activator. The platform can also be adapted to carry other hydrophobic disease-modifying compounds.

Longer Lasting Drug Delivery and Joint Lubrication

One potential advantage is a longer therapeutic window. By retaining medication locally for an extended period, the system could reduce how often patients need invasive joint injections while also lowering the possibility of systemic side effects.

The hydrogel was also designed with disease modification in mind. Rather than focusing only on pain relief, it could deliver compounds that target biological processes involved in osteoarthritis, including chronic inflammation and cellular senescence.

Another feature is its dual role inside the joint. The material functions both as a sustained-release drug delivery system and as a viscosupplement, meaning it could potentially improve joint lubrication while simultaneously delivering treatments aimed at the underlying disease.

The platform can carry poorly soluble drugs at relatively high concentrations and can be adapted for different therapeutic payloads and joint applications.

Potential Uses Beyond Knee Osteoarthritis

The primary intended application is knee osteoarthritis (large addressable market).

The same technology could also have potential uses in post-traumatic OA, intervertebral disc degeneration, rotator cuff degeneration, and the localized delivery of other hydrophobic drug candidates.

https://www.sciencedaily.com/releases/2026/08/260829235947.htm

The best exercises to ease arthritic hips and knees

From telegraph.co.uk 

By Dr Thomas Naylor

One orthopaedic doctor reveals the movements and stretches shown to both delay progression of the disease and prevent the onset of symptoms

I’ve seen over and over how patients with arthritis become inactive over fear of damaging their joints. I think orthopaedic doctors are in part to blame. We used to refer to osteoarthritis, the most common form of the disease, as “wear and tear”.

That phrase puts the idea in patients’ heads that their joints have worn away because they’ve used them too much. We know that’s not the case – your genes determine whether your cartilage will break down, or a previous injury may have damaged the surface of the joint – and a recent study from Arthritis UK has in fact found that exercise is the most effective way to reduce pain and improve mobility.

This reinforces what doctors have suspected for quite a while but now know: Physical activity is beneficial for – and protective against – all forms of arthritis, rather than causing more damage to arthritic hips and knees.

There are a number of reasons for this. Movement flushes fluid through cartilage – the smooth, slippery surface that coats the end of our bones so they can glide smoothly against each other – keeping them healthy and mobile.

Then there is the increase in strength and range of movement around the joint, as well as the very nature of being active and getting your blood flowing. All of these benefits compound on one another and make getting back into exercise the best thing you can do for painful, arthritic joints.

It can be difficult to get arthritis patients on board with exercise, but I promise it’s worth persevering. I’ve seen patients go from “I can’t go on, I need a hip replacement” to “my symptoms have improved, I don’t need surgery”.

Your new exercise routine

Dr Thomas Naylor demonstrates a standing hip abduction, one of the exercises he recommends to ease arthritis symptoms Credit: Jon Super

I’ve shared seven exercises and three stretches meant to ease arthritic hips and knees, delay its progression and even prevent the onset of arthritic symptoms in those who don’t have them yet.

Expect some discomfort if you haven’t exercised in a while, especially when doing the moves that target your range of movement. A joint that hasn’t been moved much will no longer want to move. It’s important to push through the pain, as the knee and hip will eventually become more supple and the day-to-day pain from your arthritis will reduce dramatically.

Ease yourself into this routine, being conservative with the number of repetitions. While these moves may seem simple, your stabilising muscles will be working quite hard and you may experience delayed onset muscle soreness in the following days.

This routine works best if you do it at least three times a week, and you will really feel the benefit after three months. From that point you can progress back to the activity you enjoy doing, whether that’s walking, swimming, cycling or any other sport.

If your joint pain gets progressively worse after a few weeks of following this routine, however, I would recommend seeing your GP or a musculoskeletal practitioner.

For each exercise, aim for three sets of 10 repetitions. For the stretches, hold for at least 20 seconds. Increase the number of repetitions and the duration of stretch in line with what you feel able to do.

Exercises

Seated knee extension

Arthritis benefit: Improves knee range of movement and strengthens the quadriceps (thigh muscles)

Sit on a chair with your feet resting on the floor. Keep one foot planted flat on the ground and, with your back braced against the back of the chair, straighten the other leg out in front of you. Hold that position for about five seconds, contracting the quadriceps. Relax and lower your foot to the ground. Repeat for one side as many repetitions as able, and then swap sides.

Modification: If you can’t get your leg completely straight, aim for as straight as you can. Your muscles will still be working hard, and your range of motion should increase over time.

Sit to stand

Arthritis benefit: Strengthens quadriceps and glutes and improves hip and knee mobility

Sit in a chair and rest your arms on your lap or by your side. Without pushing up with your hands, stand up. When standing, maintain good posture and push your hips forward.

Modification: Try a supported squat. Stand up with your hands on a sturdy surface, with a seat behind you, in case you lose balance. Bend your knees and lower yourself, as if you are going to sit on the chair, without doing so. Go as low as you can safely go, before standing back up.

Standing hip abduction

Arthritis benefit: Strengthens the glutes and hip abductors to stabilise the hip joint

Stand with your hands on a chair in front of or beside you. Lift one leg sideways, as high as you can, in a straight line from the side of your body, keeping your toes pointing forward. Hold this position for five seconds before lowering your leg to the floor. Repeat for one side as many repetitions as you are able, and then swap sides.

Modification: If you struggle with this exercise, lower your leg. As you get stronger and improve your range of motion, you will be able to raise your leg higher for longer. You can make it more challenging by using ankle weights to increase the load.

Standing knee raise

Arthritis benefit: Works the hip flexors, increasing the range of movement in the hip joint

Stand next to a chair, resting one hand on it for balance. Raise one leg in front of you, bending at the knee, as if you are going to kick out. Aim to have your thigh horizontal with the floor.

Modification: Lift your knee only as high as you feel comfortable.

Lying leg raise

Arthritis benefit: Engages the quadriceps and hip flexors to reduce pressure on the joint and improve hip and knee control

Lie on the floor with your legs straight and arms by your sides. Lift one leg off the floor, keeping it as straight as you can, while your resting leg remains flat and your back is flat on the floor. Hold your leg in the air for five seconds before lowering it.

Modification (displayed above): If this is too difficult, bend the knee of your resting leg so your foot is flat on the floor. This takes some of the weight off the quadriceps, making it easier to raise your leg.

Heel slides

Arthritis benefit: Improves range of movement in the knee and the hip while working the hamstrings (thigh muscles)

Lie flat on the floor. Bend one knee, keeping that foot flat on the ground. Slide your foot as close to your bum as possible and hold it there for five seconds. Slowly slide your foot back to the starting position.

Modification: If you are struggling to bring the hip and knee bent using just your leg muscles, you can use a towel looped around the ankle and help to pull the leg bent with your arms too.

Step-up

Arthritis benefit: Strengthens the quadriceps and glutes and improves movement control

Stand facing your stairs or an aerobic step. Place your foot on the step and push through it to bring your other foot onto the step. Step back down slowly, one foot at a time.

Modification: The smaller the step you use, the easier this will be. Once your confidence and control grow, you can do bigger steps or two steps at a time.

Stretches

Knee extensions

Arthritis benefit: Improves the knee’s range of movement and activates the quadriceps

Sit on the floor with your back against the wall and your legs straight in front of you. Keep one leg bent and with the foot planted flat on the floor. Roll up a towel and place it under your ankles so your straight leg is slightly elevated. Contract your thigh muscles and push the knee down towards the floor. For an even deeper stretch, use your hands to gently push down on your knee.

Hip flexor stretch

Arthritis benefit: Improves flexibility in the ligaments around the hip

Lie flat on the floor. Bend one knee up to your chest and hold the back of your thigh or the front of your knee, pulling the knee as close to your chest as possible. Repeat on the other side.

Lying hip external rotation

Arthritis benefit: Rotating the hip outwards to improve range of motion

Lie on your back and bend your knees, so your feet are together and flat on the floor. Slowly lower your knees out to the sides. Rest your hands on the inside of your knees and gently push down to deepen the stretch.

Dr Thomas Naylor is an orthopaedic surgeon and sports scientist

As told to Emily Craig

https://www.telegraph.co.uk/health-fitness/conditions/bones-joints/orthopaedic-dr-best-exercise-routine-to-treat-arthritis/

A gut health supplement found in common vegetables may reduce knee arthritis pain in six weeks, study finds

From economictimes.indiatimes.com

Synopsis

New research suggests a daily gut health supplement may reduce knee arthritis pain. Inulin, a prebiotic fibre, significantly lowered pain and improved grip strength in participants. This dietary change also reduced pain sensitivity and increased a key gut hormone. The supplement proved easier for participants to adhere to compared to physiotherapy.

A daily gut health supplement may do more than improve digestion. New research suggests it could also help reduce knee arthritis pain, improve strength, and even change how the body processes pain. Researchers found that inulin, a naturally occurring prebiotic fibre found in foods such as “chicory root, Jerusalem artichokes and other vegetables,” significantly reduced pain and improved grip strength in people with knee osteoarthritis after just six weeks.

The findings suggest that targeting gut bacteria could become a valuable addition to existing arthritis treatments, though the researchers stress that larger studies are still needed before the supplement can be recommended routinely.

What did the study investigate?

The study, published in Nutrients, titled "Effect of Prebiotic Supplementation With and Without Physiotherapy on Pain and Pain Sensitivity in People with Knee Osteoarthritis," was conducted by researchers from the University of Nottingham and collaborators.

It examined whether improving gut health through a prebiotic supplement could reduce pain associated with knee osteoarthritis, either alone or alongside physiotherapy.

The researchers recruited 117 adults with symptomatic knee osteoarthritis and randomly assigned them to one of four groups:

• Inulin supplementation
  
• Physiotherapy-supported exercise
  
• A combination of inulin and physiotherapy
  
• Placebo
• 
  
• Participants followed their assigned treatment for six weeks, after which researchers assessed changes in pain, physical function, pain sensitivity, and biological markers linked to gut health and inflammation.

                                                                                                                         (Representative image)

• 
  
• The supplement reduced pain and improved strength

Compared with those receiving the placebo, participants taking inulin experienced:

• Reduced knee pain
  
• Improved grip strength
  
• Lower pain sensitivity
  
• Increased levels of GLP-1, a gut hormone linked to pain regulation and muscle function
  

Interestingly, while exercise also helped reduce knee pain, it did not improve grip strength or pain sensitivity to the same extent as the prebiotic supplement.

According to the researchers, the findings suggest that altering the gut microbiome may influence not only inflammation but also the nervous system's response to pain.

“This study raises the exciting possibility that a simple dietary change - adding a fibre supplement to your breakfast or yogurt - could meaningfully reduce pain and improve physical function." Afroditi Kouraki, lead author of the study said.

How can a gut supplement affect arthritis?

Unlike probiotics, which introduce beneficial bacteria into the digestive system, prebiotics serve as food for the beneficial bacteria already living in the gut. When gut microbes ferment inulin, they produce short-chain fatty acids, including butyrate, which are known to influence immune function, inflammation, and communication between the gut and the brain.

The researchers propose that these biological changes may partly explain why participants reported less pain and showed reduced pain sensitivity after supplementation. Higher GLP-1 levels were also associated with stronger grip strength, suggesting a possible connection between gut health, muscle function, and pain perception.

Participants found the supplement easier to stick with

The study also highlighted an important practical advantage. Only 3.6% of participants receiving the inulin supplement dropped out of the trial, compared with 21% of those assigned to physiotherapy-supported exercise.

Not a cure for arthritis

Despite the encouraging results, the authors caution against viewing inulin as a cure. The trial lasted only six weeks and involved a relatively small group of participants with knee osteoarthritis. The findings cannot yet be applied to other forms of arthritis, such as rheumatoid arthritis, and longer-term studies involving larger populations will be needed to confirm the benefits and determine the optimal dosage.

https://economictimes.indiatimes.com/us/news/a-gut-health-supplement-found-in-common-vegetables-may-reduce-knee-arthritis-pain-in-six-weeks-study-finds/articleshow/132656329.cms?from=mdr