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Disease-modifying therapies for osteoarthritis : current status
Marc Fajardo1, Paul E Di Cesare
1Musculoskeletal Research Center, NYU-Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York, New York 10003, USA.
Drugs & Aging
|March 1, 2005
Summary
Osteoarthritis treatments range from pain relief to disease modification. Current options include medications and physical therapies, with ongoing research into novel approaches to slow or reverse joint degeneration.
Area of Science:
- Rheumatology and Orthopedics
- Pharmacology and Therapeutics
- Biomedical Sciences
Background:
- Osteoarthritis (OA) is a prevalent, progressive degenerative joint disease primarily affecting the elderly.
- Therapeutic strategies for OA have evolved from solely symptomatic management to exploring disease-modifying interventions.
- Understanding OA pathophysiology involves examining cartilage, synovial fluid, and subchondral bone mechanisms.
Purpose of the Study:
- To review the pathophysiology of osteoarthritis, including underlying mechanisms and the roles of joint components.
- To discuss current and emerging therapeutic approaches for osteoarthritis, with a focus on pharmacological treatments.
- To evaluate the efficacy and limitations of various OA treatment modalities.
Main Methods:
- Review of existing literature on osteoarthritis pathophysiology and treatment strategies.
- Analysis of pharmacological treatments including analgesics, NSAIDs, COX-2 inhibitors, corticosteroids, viscosupplementation, and nutraceuticals.
- Examination of non-pharmacological modalities (physical therapy, exercise, weight management, orthotics) and surgical options.
- Inclusion of established and experimental therapies such as colchicine, bisphosphonates, hormones, dietary agents, and gene therapy.
Main Results:
- Current OA treatments focus on pain reduction and mobility maintenance, with limited disease-modifying effects.
- Analgesics show less efficacy than NSAIDs; NSAIDs have mixed results on joint space narrowing.
- COX-2 inhibitors are effective but raise cardiovascular safety concerns.
- Injectable therapies offer short-term relief without structural modification.
- Symptomatic slow-acting drugs (e.g., chondroitin, glucosamine sulfate) show promise.
- Experimental therapies aim to modify or reverse OA progression.
Conclusions:
- Osteoarthritis remains challenging to treat, lacking a definitive cure.
- Current management prioritizes symptom control and functional preservation.
- Continued research is essential for developing treatments that can alter the degenerative course of OA.