Stopping osteoarthritis: Could recent heart research provide a clue? – . Health Blog

Here is a recent headline that I found confusing: Could the First Drug That Slows Arthritis Be Here?

It's confusing because it depends on which of the 100+ types of arthritis we're discussing. We have had drugs that slow rheumatoid arthritis for decades. In fact, more than a dozen FDA-approved drugs can reduce or even stop joint damage in people with rheumatoid arthritis. We also have effective drugs to slow or stop gout, another common arthritis.

However, the heading refers to osteoarthritis, the most common arthritis. And currently, no drugs can safely and reliably slow the pace of this worsening joint disease. This is one of the reasons why so many knee and hip replacements are performed: more than 1.2 million annually in the US alone.

A drug that can slow joint degeneration in osteoarthritis has long been the holy grail of arthritis treatments because it could

Alleviate pain and alleviate suffering for millions of people
help to prevent the loss of function associated with osteoarthritis
Reduce the need for surgery and the associated risks, costs, and the time it takes to recover.

And of course, such a drug would generate huge profits for the drug company that developed it first.

A study of heart disease may have identified a new treatment for osteoarthritis

According to a new study published in Annals of Internal Medicine, it is possible that such a treatment exists and is already being used to treat other conditions. The researchers re-analyzed data from more than 10,000 people who originally looked at whether the drug canakinumab would be beneficial for people with a previous heart attack – yes, heart attack, not arthritis.

Canakinumab works by blocking interleukin-1, a substance that is closely related to inflammation. Growing evidence suggests that inflammation increases the risk of cardiovascular disease and may predict future cardiovascular problems. All study participants had previously had a heart attack. They also had high levels of CRP (C-reactive protein) in their blood, an indicator of inflammation in the body.

Every three months, each person received an injection of one of multiple doses of canakinumab or a placebo. Canakinumab appeared to work for heart disease: those who received the 150 mg dose of canakinumab had significantly fewer cardiovascular complications (repeated myocardial infarction, stroke, or cardiovascular death) over about four years. Unfortunately, there was also a higher rate of fatal infections among subjects treated with canakinumab.

Another look at this study from canakinumab

The reanalysis compares the rates of hip or knee replacement due to osteoarthritis in patients receiving canakinumab with those in patients receiving placebo. The study's authors believed that since canakinumab reduces inflammation, it could reduce inflammation in the joints of people with osteoarthritis while providing cardiovascular benefits.

Osteoarthritis has long been considered a worn, age-related and non-inflammatory form of joint disease. However, over the past decade, research has shown that there is some level of inflammation in osteoarthritis. So it's not too difficult to believe that a drug like canakinumab could be effective for osteoarthritis. This drug is already approved for a number of inflammatory diseases, including certain forms of pediatric arthritis.

The results of this new study surprised me: Over a four-year period, those who received canakinumab were at least 40% less likely to receive a hip or knee replacement than those who received placebo.

Warning: These results are preliminary

Before declaring victory over osteoarthritis with treatment with canakinumab, it is important to acknowledge that this study does not prove that it actually works. It's because of the negotiation

was not a treatment study in people with osteoarthritis. More than 80% of the participants had no history of osteoarthritis.
did not compare x-rays or other imaging tests before and after treatment to confirm the diagnosis of osteoarthritis, or showed that treatment was slowing its progression
did not judge whether joint pain was present before treatment or improved after treatment. It's possible that people taking canakinumab may have fewer joint replacements because the drug relieves pain instead of slowing down joint damage. Possibly the drug can delay the need for joint replacement by reducing symptoms without slowing the progression of joint damage.
lasted about four years. The results could have been different if they had taken longer.
only included people who had previously had a heart attack and elevated CRP. Results may not apply to people who have no history of cardiovascular problems or normal CRP.

To find out if canakinumab can actually slow osteoarthritis, we need an appropriate study that includes people with osteoarthritis and compares symptoms and x-rays after treatment with canakinumab or placebo.

Canakinumab is expensive, nearly $ 70,000 a year (although discounts, insurance coverage, and copays vary), and is only available by injection. It's not clear how many people with osteoarthritis would accept such treatment. If it's shown to be highly effective in preventing the need for joint replacement surgery, its high cost may be easier to accept.

The final result

We need definitive information on the potential of canakinumab or related drugs to treat osteoarthritis and to slow its progression. Until then, it is unlikely to become a common option.

If you have osteoarthritis of the knees or hips, talk to your doctor about your options, including maintaining a healthy weight, staying active, and taking pain medication as needed. Some people get better with walking aids (such as a stick) or knee braces (for knee arthritis). Joint replacement surgery can be viewed as a last resort.

As for new treatments that can slow the progression of osteoarthritis, we should be hopeful. But we're not there yet.

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