Doctors Not Following Arthritis Guidelines

A number of professional bodies have released osteoarthritis guidelines summarizing the different treatments and the evidence behind them. They are meant to guide physicians, informing them of the treatments that have been shown to work effectively.

One example of such a set of guidelines is the review produced by the American Academy of Orthopedic Surgeons on knee osteoarthritis (to view, click here).

A new paper to be published in Arthritis Care and Research in January 2011 states that doctors are relying on analgesia and surgery while ignoring evidence based treatments such as weight loss and exercise. The study also reported that there is excessive use of radiological investigations, in particular MRI. They estimate that 50% of the MRI scans done for osteoarthritis each year in the USA are unnecessary.

As the population ages, the cost of treatment is going to rapidly rise and it is likely pressure will be applied to encourage evidence backed treatments. Existing treatments such as arthroscopic 'washout' that have been shown to be of little benefit will be placed under the microscope as health care costs soar.

For more on the article, click here.

Different Types of Pain

Pain comes in many forms. There is more to pain than just its intensity, there is also a quality to pain.
Think of the different ways it is described: Stabbing, aching, itching, deep, surface, tooth ache, electric etc.

A recent study used the example of Carpal Tunnel Syndrome to investigate these qualities of pain. The results were interesting.

Pain intensity alone did not determine the amount of dysfunction the subjects suffered. They found that the quality of pain was an important variable and that pain described as "throbbing" and "itching" were the two most likely to cause disrupted sleep and disability.

Given the wide number of ways the pain of osteoarthritis is reported, it is likely this needs to be considered when treating this condition.

For more information on the article click here

Stem Cell Treatment For Osteoarthritis

Many people suffering from osteoarthritis try and put off any surgical intervention until the last minute hoping that a new treatment will be developed in the future. Many theoretical treatments appear in the media but they are often no more than a possible direction for new research.


British scientists are making the news as they have announced the human trial of a new stem cell treatment due to start at the end of the year.
Stem cells are exciting researchers as they have the ability to turn into many different types of cells found throughout the body. The study plans to add stem cells to cartilage cells that have been harvested from the affected joint before being replanted to cover a worn area.


This technique has been used for over ten years to cover limited areas of worn articular cartilage in the knee. It is hoped that the addition of stem cells will improve results, extending their benefit and hopefully allowing the treatment of larger defects.
The knee is the focus of this study but it is encouraging to see human trials that could lead to the development of new treatments that are widely available in a matter of years.

Source: Knee Arthritis - Stem Cell Therapy

Keep Active - Any Way You Can

The elderly often get caught in the vicious cycle of osteoarthritis. Pain leads to a reduction in activity, which results in a decrease in supporting muscle strength, which causes more pain.

This is why the majority of people experience rapidly increasing pain.

The good news? It works the other way as well.

If you can find a way to increase your level of activity or exercise without causing a sharp increase in pain, life improves. Your muscle strength increases and your existing arthritis causes less pain. This encourages you to be more mobile and the cycle of benefit continues.

So how do you get the average person to be more active? This is the challenge. I have always recommended anyone with osteoarthritis seek the advice of a physical therapist. They can take you through the process of finding the exercise that increases muscle strength without increasing pain.

With those people who have minimal physical activity, any method of increasing their general movement is of benefit.

A recent study has looked at the use of a Nintendo Wii gaming console in promoting physical activity in the elderly. They found that this device encouraged the overweight user to burn up to 176 calories within half an hour. When it comes to keeping active, it doesn't matter how you do it, the benefits are the same.

Hormone Replacement to Treat Osteoarthritis

A German study could lead to the development of new osteoarthritis treatments.

Researcher in Goettingen looked at a type of cell called Chondrogenic Progenitor Cells (CPCs) that may have cartilage regeneration properties. These cells are sensitive to hormone levels suggesting that their activity could be influenced by injecting hormones into the synovial fluid in joints affected by arthritis.

The researchers found that these cells were present in over 95% of arthritis sufferers indicating that any treatment developed would be effective for the majority of cases. This information could lead to a new way of helping the body combat osteoarthritis via a minimally invasive technique.

The study's authors have suggested further research into this area, and although a practical application is some way off, the findings offer hope to those affected by osteoarthritis.

The article abstract can be viewed here.

What Other Joints Can Be Replaced?

Osteoarthritis mainly affects the weight bearing joints of the body. This means the most common sites are hips, knees, lumbar spine and cervical spine.

Hip and Knee Replacements are well know operations as they are performed on thousands of people every day. These procedures are very successful and have a positive effect on quality of life.

A commonly asked question is: What other osteoarthritic joints can be replaced?

Total Shoulder Replacements are commonly performed but much less often as the incidence of shoulder arthritis is less because our arms bear weight sporadically unlike our legs.

Elbow replacements can also be performed although this is usually due to rheumatoid arthritis rather than osteoarthritis.

Wrist replacements are relatively uncommon but the technology exists to perform them.

Hand surgeons are also able to replace individual knuckle joints in the fingers. These intricate operations need intensive physical therapy to regain range of motion and function.

In the lower limb, ankle replacements are also performed. They have been around for many years but due to a high failure rate in early models they fell from favor. They are now making a bit of a comeback but due to the fact that ankle fusions are simple, effective at relieving pain, and offer reasonable function, their numbers are still relatively low.

Due to the specific nature of these operations they are generally performed by surgeons specializing in that joint. Many well rounded surgeons perform both hip and knee replacements but it is unlikely you will find one surgeon offering both ankle and wrist replacements.

Everyone's personal situation is different so the usual advice remains - Discuss your arthritis with your surgeon or doctor to see if joint replacement is right for you.

The Future of Osteoarthritis Treatment

The development of knee and hip replacements was a major step in the treatment of osteoarthritis. These operations have relieved pain and increased the quality of life of millions of people worldwide and continue to demonstrate great results. Unfortunately there are some downsides with these procedures.

Firstly, despite being very common, they are significant surgical undertakings. This brings with it all of the usual surgical and anesthetic complications - infection, blood clots, nerve damage, fractures, dislocations, chest infections and even the occasional death.

Secondly, joint replacements have a limited life span. This is why surgeons are often reluctant to operate on 'young' people. Modern surgical prostheses have excellent wear properties - it is uncommon for the materials to fail. The reason the joint replacements 'wear out' is that they become loose. It doesn't matter what the replacement is made out of, it still has to attach onto our bones and these bones are not getting any younger. Another property that causes loosening is the fact that our bones are not 100% rigid. They are close to it, but they do 'bend' tiny amounts when we weight bear. Joint replacements don't bend so the difference in rigidity, although absolutely minute, adds up over time. Having a joint replacement revised is a much more technically difficult operation and the results tend to be significantly worse.

The Future?

Millions of dollars is being spent every year trying to come up with a way of re-growing the articular cartilage that wears away in osteoarthritis. The goal is to come up with a minimally invasive treatment that can restore pain-free movement. Small steps are being made and treatments such as Autologous Chondrocyte Implantation can treat small defects in the joint surface. Its disadvantages are that it requires two operations (and as such is expensive), has a long rehabilitation, and can't treat the whole surface of the joint that is often affected with osteoarthritis.

Some small steps are being achieved. A recent animal study had some success treating osteoarthritis in rabbits using nanofiber technology to create a gel that worked with the body to cover a joint defect. Treatments like this are still a long way off being ready for the average arthritis sufferer but offer hope to the millions of people dealing with osteoarthritis every day.