To Stop Osteoarthritis, Fixing Cartilage May Not Be Enough

Fifty years ago, doctors knew little about osteoarthritis except that it damaged the joints and sometimes caused excessive pain. Today, the dis-ease is far better understood—re-searchers have gained insight into the mechanical, genetic, and biochemi-cal factors underlying osteoarthri-tis, and many pharmaceutical com-panies have long-standing programs devoted to the search for ways to prevent or slow the disease. How-ever—notwithstanding the advent of surgery—most people with os-teoarthritis today are little better off than those who had it 50 years ago. There is still no way to stop the progress of osteoarthritis once it starts corrupting joints. Treatment is symptomatic, focusing on strategies to reduce pain and disability. Pain is commonly managed with over-the-counter and prescription pain-reliev-ing medications. Doctors also coun-sel patients to lose weight, if needed, and to exercise; even modest weight loss among obese patients can reduce symptoms by taking stress off of joints, and walking and other exer-cises can help strengthen muscles and create more flexible joints. When all else fails and the disease causes seri-ous pain and disability, some people require surgery. Without more effec-tive treatment to stop painful osteo-arthritis, the demand for surgery is expected to rise dramatically. A re-cent projection study prepared for the American Academy of Orthopae-dic Surgeons estimated a 673 % in-crease in total knee replacements and a 174 % increase in total hip replace-ments by 2030 (1). The study also estimated that revision surgeries for total hip and total knee replacements would more than double over the next 2 decades. Surgeons pioneered total joint replacement procedures in the 1950s and 1960s. Few doctors back then would have guessed that so much time would pass without the arrival of other ways to change the course of the disease. “In the intervening years since the development of total joint replacement, we have learned a lot about osteoarthritis. But we still can’t stop the disease, ” said Kenneth Brandt, MD, professor emeritus of medicine and orthopedic surgery a