Osteoarthritis

Background

Clinical Trials SquareOsteoarthritis (OA) is the most common form of arthritis, impacting many joints and most commonly found in the hands, knees, hips and back. The symptoms include pain, stiffness, swelling of joints, and can progress to where reduced mobility and bone spurs occur in some patients. The cause of OA is simply the use of the joints resulting in the gradual reduction of the protective cartilage that covers the points of contact. Over time, this cartilage degrades and one can be left with bone rubbing on bone. There has been a significant increase in OA, with 21 million adult cases involving the hand, hip or knee in 1995 increasing to 27 million in 2005.

Current Treatment

Many people can manage arthritis with conservative measures, and most will eventually get to the point of pain and mobility limitations which prompt them to seek medical help. Care options include anti-inflammatory and other medications, physical therapy, and can also include injections into the effected joint. Many have such severe pain, that a total joint (TJ) replacement surgery is considered or completed. While TJ surgery can improve these problems, TJ is a major surgery, and does have risks. These include bleeding, infection, mobility limitations, poor alignment or even dislocation of the replacement joint. Infections of TJ are a significant problem, as the presence of a foreign body (that is, the replacement joint) can make it very difficult to completely treat the infection. At times, the joint must be completely removed in order to completely resolve the infection. There are also limitations to the lifespan of the TJ replacements, which can result in the need for a second TJ replacement surgery.

Focused Ultrasound Treatment

The use of focused ultrasound for osteoarthritis is still in the early stages. There are clinical trials being done to see if the nerves that carry pain from the joints can be treated so that the pain experienced is reduced. These studies are looking at the impact for knees, hips and hands. It is important to remember that the aim is not to treat the arthritis, but to reduce the pain that people feel from the arthritic joints. The benefit of this treatment is that it can delay or avoid TJ surgery and improve comfort and activity for the patient. This procedure can potentially help a patient avoid requiring a second TJ, by virtue of delaying the time until a first TJ is done.

Clinical Trials

A recently completed clinical trial in Europe treated patients with knee pain, and results are pending. An upcoming European trial will be looking at treating patients with OA in the hands and hips. Both of these trials are looking at treating pain from OA, as was discussed above. There is also a clinical trial for treatment of nerves that produce back pain, which may have an osteoarthritis component. For more information on this work, please see the section on back pain.

Notable Papers

Izumi M, Ikeuchi M, Kawasaki M, Ushida T, Morio K, Namba H, Graven-Nielsen T, Ogawa Y, Tani T. MR-guided focused ultrasound for the novel and innovative management of osteoarthritic knee pain. BMC Musculoskelet Disord. 2013 Sep 13;14:267. doi: 10.1186/1471-2474-14-267.

Weeks EM, Platt MW, Gedroyc W. MRI-guided focused ultrasound (MRgFUS) to treat facet joint osteoarthritis low back pain--case series of an innovative new technique. Eur Radiol. 2012 Dec;22(12):2822-35. doi: 10.1007/s00330-012-2628-6. Epub 2012 Aug 31.

     

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