J Rheum Dis Treat ISSN: 2469-5726

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Journal of Rheumatic Diseases and Treatment

National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil

Non-operative treatment of knee osteoarthritis has gained special interest between patients and orthopedic surgeons, not only to alleviate pain and improve function, but also to postpone joint replacements. Projections showed an increase of 673% in the number of arthroplasties to be performed in the United States through 2030 [1,2].

Conservative treatment of osteoarthritis includes both non-pharmacological and pharmacological approaches. It should involve patient´s participation and be based on a pool of actions, such as weight loss, physical therapy, exercise and, not solely on medications. Moreover, treatment should be individualized according to the patients´ needs [3].

Pharmacological options have widened and are far beyond analgesics and non-steroid drugs. Chondroprotective agents and viscosupplementation prescription have increased and are now accessible to a broader part of the population. Although the improvements confirmed by clinical studies using such treatments, still today there is no consensus on which one would offer the better results [4]. Some claim that researches are biased by the influence of pharmaceutical industry, which sponsored many of them, justifying the divergent results published.

Another issue is the lack of understanding about some principles involving genetics and mechanisms of disease [5]. Recently, it has been reported the involvement of CXCR1/2 in cartilage homeostasis signaling [6]. Additionally, the activity of the biomarker TSG-6 was associated to osteoarthritis progression [7]. On the other hand, several microRNAs were described as regulating chondrocyte gene´s expression with potential use on therapeutics [8]. Another approach may involve genetic manipulation of stem cells and growth factors, modulating tissue repair [9].

Understanding these mechanisms may provide a clue for the development of biological agents such as the ones used successfully in the treatment of rheumatoid arthritis. Our role as clinicians and researchers is actually to work on these issues. If not, maybe we´ll be fearing the future.

References

1. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, et al. (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73: 1323-1330.
   


2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg 89: 780-785.
   


3. McAllindon TE, Bannuru RR, Sullivan MC, Arden NK, Berembaum F, et al. (2014) OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 22: 363-388.
   


4. Block JA (2014) Osteoarthritis: OA guidelines: improving care or merely codifying practice? Nat Rev Rheumatol 10: 324-326.
   


5. Felson DT (2014) Osteoarthritis: priorities for osteoarthritis research: much to be done. Nat Rev Rheumatol 10: 447-448.
   


6. Sherwood J, Bertrand J, Nalesso G, Poulet B, Pitsillides A, et al. (2014) A homeostatic function of CXCR2 signalling in articular cartilage. Ann Rheum Dis.
   


7. Wisniewski HG, Colón E, Liublinska V, Karia RJ, Stabler TV, et al. (2014) TSG-6 activity as a novel biomarker of progression in knee osteoarthritis. Osteoarthritis Cartilage 22: 235-241.
   


8. Tsezou A (2014) Osteoarthritis year in review 2014: genetics and genomics. Osteoarthritis Cartilage 22: 2017-2024.
   


9. van Osch GJ (2014) Osteoarthritis year in review 2014: highlighting innovations in basic research and clinical applications in regenerative medicine. Osteoarthritis Cartilage 22: 2013-2016.