BIRMINGHAM, ENGLAND — Structural modification that could be achieved through mechanical, behavioral, and nutritional therapies may be a worthwhile goal in osteoarthritis treatment and a way to focus on therapy that involves more than just symptom relief, according to a presentation at the annual meeting of the British Society for Rheumatology.
A multitude of nonpharmacologic options for osteoarthritis can be pursued prior to drug treatment, Dr. Paul Dieppe said. For example, small studies support the theory that mechanically shifting the load off an affected lower-extremity joint modifies structure and alleviates symptoms of osteoarthritis.
Osteotomy, shoe wedging, and knee braces, as well as weight loss in the obese, are other options.
“If we kept thin, ate sensibly, maintained good muscle strength, avoided injuring our joints, and wore sensible shoes … there might not be as much osteoarthritis,” said Dr. Dieppe, professor of rheumatology and dean of the faculty of medicine, University of Bristol (England).
Dr. Dieppe says he is unhappy with the fact that people borrow the term “disease-modifying treatment” from the rheumatoid arthritis field and apply it to osteoarthritis.
“We go on pretending that osteoarthritis is related to rheumatoid arthritis, and just a bit different. What might disease-modifying treatment mean in osteoarthritis? We are talking about structure modification,” he said.
Structural changes can be achieved with Ilizarov frames—more commonly used by orthopedists to correct limb length discrepancies. The frames pull and increase the space between joints.
“Strangely, most of the data [so far have come] from the ankle joint,” Dr. Dieppe said. “The trials are small in numbers, but suggest very positive outcomes with recovery of the joint space in many cases, as well as symptom relief.”
Success with these frames provides proof of the concept that if the joint is unloaded, there is structure and symptom modification.
“It looks gruesome, but clearly, it can work,” Dr. Dieppe said.
Investigators should assess crepe shoes, shoe wedging, and other less invasive interventions, he added.
Osteoarthritis of the knee begins when a kinematic change occurs and shifts the load of the joint to a region unaccustomed to the new loading, according to a review article (Curr. Opin. Rheumatol. 2006;18:514–8). The authors state that the progression of osteoarthritis thereby is associated with the degree of this increased load during ambulation.
In terms of nutritional modification, trials are underway to assess any roles for vitamin C or vitamin D to slow the pathogenesis or progression of osteoarthritis, Dr. Dieppe said. Altering the course of osteoarthritis with certain dietary supplements does not work, he said, adding, “That chondroitin or glucosamine causes structural changes is a silly idea.”
“The relationship between symptom change and structural change requires further study,” he concluded.