En espanol l Stephen Barry couldn't remember a time during the past 10 years when his hip didn't cause him pain. On many occasions the discomfort was so severe, he says, that he could barely step from the dock near his Davidsonville, Maryland, home into his boat. The retired educator, 64, took medications and exercised "religiously," but nothing seemed to help.
Barry suffers from osteoarthritis (OA), an often debilitating disease caused mainly by wear and tear on the joints. In its most advanced form, OA results in the complete loss of cartilage in a joint, causing bone to rub against bone. Some 27 million Americans have OA — more than any other chronic disease except heart disease and cancer.
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Until fairly recently, doctors have been limited in their treatment options: exercise, anti-inflammatory drugs, physical therapy and, more dramatically, joint replacement — the route Barry finally took to get the relief he needed. In recent years, though, several lesser-known treatments have emerged.
1. Pain Relief
In 2010, the Food and Drug Administration (FDA) approved the drug Cymbalta to treat pain associated with osteoarthritis. First approved in 2004 to counteract major depressive disorders, Cymbalta boosts levels of serotonin and norepinephrine in the brain, inhibiting pain perception. But Cymbalta doesn't work for everyone. That's why researchers are increasingly excited about new ways to block nerve growth factors, proteins in cells that are consistently elevated in those who experience chronic pain.
In particular, doctors have high hopes for a medication called tanezumab, which seems to inhibit nerve growth factors. In 2010, the FDA halted clinical trials of tanezumab after some patients' osteoarthritis worsened. After reexamining the data, the FDA has cleared the way for more controlled clinical trials to resume.
Our joints are bathed in synovial fluid, a clear, gel-like substance that provides lubrication. Within the synovial fluid is hyaluronic acid, which deteriorates in those with OA. Doctors will frequently inject synthetic hyaluronic acid into patients' joints to reduce pain. "I'd say 70 percent of my patients get 70 percent better," says Fred Redfern, M.D., an orthopedic surgeon in Henderson, Nevada, who treats hundreds of patients this way. "It buys time, and side effects are rare."
Platelet-rich plasma (PRP) injections — which involve withdrawing blood from a patient, spinning it to separate the platelets and then injecting the concentrated platelets into a joint — also have shown great promise. In a study published last year, 15 patients were injected with PRP in a knee and monitored for 12 months. Most experienced a decrease in pain.
Even more recently, stem cell injections have been used to treat knee injuries, especially in professional athletes. A study published in January in the Journal of Bone and Joint Surgery found that patients with osteoarthritis who received a stem cell injection also experienced reduced pain.
As the name implies, this procedure involves distracting the stress on a joint by creating a metal frame outside the skin around the joint and anchoring the frame surgically to the bones above and below. The frame absorbs the weight, but the real benefit comes from the bones' separating. The ends of the bones become softer, enhancing blood flow and stimulating the growth of cartilage. A study published last year in Osteoarthritis and Cartilage showed that 15 of 23 European patients with advanced osteoarthritis had substantial reduction in pain and improvement in function for two years following knee distraction.
Distraction does have drawbacks. Knee distraction is not widely available in the U.S. (most patients opt for full knee replacement). The frames stay on for months. Rehabilitation is long. And the cartilage produced may be less durable than natural cartilage. Nevertheless, Annunziato Amendola, M.D., director of the University of Iowa Sports Medicine Center, says most of his ankle-distraction patients are "doing very well."
4. Cartilage Replacement
Because it's the loss of cartilage that makes osteoarthritis so painful, researchers have focused on finding ways to replace this connective tissue. Autologous chondrocyte implantation, or ACI, involves doctors' taking a small amount of cartilage from the patient's joint, cultivating the cells, sealing the affected area and injecting the cultivated cells under the seal. For all its promise, though, ACI works only when the arthritis is contained in a relatively small area.
That's why doctors are excited about recent research published in theProceedings of the National Academy of Sciences, in which scientists were able to prod bone marrow stem cells to act like cartilage. "Come up with something that regenerates cartilage and you have the Holy Grail," says Eric Ruderman, M.D., professor in medicine-rheumatology at Northwestern University in Chicago.
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