Osteoarthritis is characterized by cartilage breakdown, joint stiffness, and pain. It is the third most prevalent type of musculoskeletal pain.

• Cartilage breakdown is not necessarily associated with pain because cartilage is minimally innervated with nociceptors (nerve cells that feel pain). The synovium membrane and subchondral bone, on the other hand, are highly innervated with pain receptors.

• Referred muscle pain is common in the late stages of osteoarthritis. Patients may experience wide spread hyperalgesia due to pain centralization. 

• Pain centralization is changes in the way the nervous system processes and responds to pain signals.

• Joint degeneration can change gait functions such as speed, knee joint loading, and alignment.

• Poor quality of sleep is also common. This leads to higher levels of depression, anxiety, and pain catastrophizing. These symptoms combined can lead to an increase in pain.

• Obesity and increasing age are associated with a higher risk of developing osteoarthritis. Obesity can lead to osteoarthritis in weight bearing and non-weight bearing joints which indicates that it is due to an underlying inflammatory process that occurs with obesity.

• The most common treatments for osteoarthritis include:

• Exercise based therapy in combination with pain education (weight loss if needed)

• Nonsteroidal anti-inflammatory drugs

• Arthroplasty surgery

• Arthroplasty is an ideal treatment for patients who experience localized osteoarthritis problems. 80% of patients experience major pain improvement after surgery.

• Duloxetine is recommended for patients with wide spread pain and depression.

Updated Research on Osteoarthritis

• A study tested the effects of combining glucosamine hydrochloride with non-steroidal anti-inflammatory drugs on people with knee osteoarthritis

• There was a decrease in the expression levels of inflammatory cytokines

• There was a decrease in knee pain and arthritis symptoms

• There was an improvement in knee function

• A study tested the effects of high-intensity laser therapy combined with targeted hand function training on people who had carpometacarpal osteoarthritis

• The study last from April 2020 to April 2022. The participants were females ranging from 58 to 80 years old.

• The study proved that high-intensity laser therapy combined with targeted hand function training is more effective for decreasing pain and increase grip strength compared to more traditional methods.

• A study was done on a new method to deliver medicine to the joints of people with osteoarthritis

• We have cells in our bones called “exosomes” which are like little bubbles; they can carry medicine, but they disappear from the body quickly and don’t stay where they are needed

• Researchers decided to improve these exosomes by putting them in a squishy material called hydrogel. They also added a piece to exosomes to make them stick to the joints better. The exosomes were then loaded with medicine that treats osteoarthritis.

• When tested on animals, the exosomes stayed in the joints longer and they stopped inflammation. The exosomes were also tested on human joints in a lab and had good results.

• A study was done to assess the effects of foot-ankle strengthening on pain and function in individuals with osteoarthritis

• An 8-week foot-ankle strengthening program was done on people with osteoarthritis of the knee.

• There were positive effects on knee pain and physical function in those with knee osteoarthritis.

• A study was done effects of an intramuscular injection of calcitonin on pain and functional status in people with knee osteoarthritis

• There were 40 participants ranging from 53 to 55 years old. They had similar weights and body sizes. The participants received calitonin once a week for 4 weeks

• After one month, there was a significant decrease in pain and the participants were able to move their joints more easily

Takeaways:

• Arthroplasty is an ideal treatment for patients who experience localized arthritis.

• Obesity increases the risk of developing osteoarthritis. Weight loss may be needed to reduce osteoarthritis.

• Calcitonin injections may be used in the future to treat osteoarthritis.

Note from the Author: Chronic Pain Hope strongly encourages the use of mind-body treatment methods such as pain reprocessing therapy, hypnosis, virtual reality, mindfulness, and meditation in the treatment of osteoarthritis. These treatments are not meant to be used in place of the treatments listed above but alongside those treatments. Mind-body treatments may be most effective when used before, during, and after a joint replacement.

Sources:

Wang F, Liu G, Shi J, Wang J, Zheng S, Shi Q, Pan H. Effects of glucosamine hydrochloride combined with non-steroidal anti-inflammatory drugs on symptoms and HSS scores in patients with knee osteoarthritis. Pak J Pharm Sci. 2023 Jul;36(4(Special)):1337-1341. PMID: 37606025.

Guo Q, Zhang ZM, Fan JH, Zhu JY, Wei XL. [High-intensity laser therapy combined with targeted hand function training for the treatment of grade 1-2 thumb carpometacarpal osteoarthritis]. Zhongguo Gu Shang. 2023 Aug 25;36(8):743-7. Chinese. doi: 10.12200/j.issn.1003-0034.2023.08.009. PMID: 37605913.

Wan J, He Z, Peng R, Wu X, Zhu Z, Cui J, Hao X, Chen A, Zhang J, Cheng P. Injectable photocrosslinking spherical hydrogel-encapsulated targeting peptide-modified engineered exosomes for osteoarthritis therapy. J Nanobiotechnology. 2023 Aug 21;21(1):284. doi: 10.1186/s12951-023-02050-7. PMID: 37605203.

Dantas GAF, Sacco ICN, Ferrari AV, Matias AB, Watari R, Oliveira LVM, Marcon TR, Fatore JA, Pott-Junior H, Salvini TF. Effects of a foot-ankle muscle strengthening program on pain and function in individuals with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther. 2023 Aug 11;27(4):100531. doi: 10.1016/j.bjpt.2023.100531. Epub ahead of print. PMID: 37603935.

Hertel, E., & KJaer-Staal Petersen, K. (2023, August 2). Pain in osteoarthritis. International Association for the Study of Pain (IASP). https://www.iasp-pain.org/resources/fact-sheets/pain-in-osteoarthritis/