What are the treatment options for osteoarthritis sufferers who aren’t suitable for surgery – and what does that tell us about the nature of osteoarthritis itself? Jim Newman explains, with the help of recent research into a familiar drug.

There’s more than one type of arthritis and two of the most common are osteoarthritis and rheumatoid arthritis. Google the difference between the two, and you’ll find lots of material that says something along the lines of ‘rheumatoid arthritis is an autoimmune disease where the immune system attacks the tissues in your joints. Osteoarthritis is caused by wear and tear, with the cartilage of the joints gradually worn away until bone grinds on bone.’

Except we now know that’s not exactly true.

Rheumatoid arthritis is an autoimmune condition. But osteoarthritis and wear and tear? That’s not the whole story.

> What Is Osteoarthritis & How Do You Treat It?

An inflammatory problem

How do we know that’s not the whole story? Well, one reason is because of the effect on osteoarthritis of a drug traditionally used to treat rheumatoid arthritis: methotrexate.

A recent study of osteoarthritis patients found that taking methotrexate resulted in a “statistically significant” reduction in pain, stiffness and function after six months. “Statistically significant” is sort of research paper code for not insignificant but also not especially significant. In truth, the drug led to a less than 10% improvement in stiffness and function, so not lifechanging, but also not to be sniffed at, especially if you’re in severe arthritic pain.

The important point from our perspective, though, is that methotrexate is an anti-inflammatory – it interrupts the normal inflammatory pathways (a bit like a super-powered Voltarol) – and that tells us something about the nature of osteoarthritis (OA). If OA was solely a degenerative condition caused by aging joints wearing away, methotrexate wouldn’t have any effect. The fact that it does tells us that arthritis is also an inflammatory problem, and it demonstrates that this inflammatory element contributes to the pain of osteoarthritis.

> Discover more about osteoarthritis, YKC & you

Practical applications

All of which is very interesting to a clinician, but you’re probably asking what difference this study will make to your knee pain. In most cases, the answer will be ‘not very much’. Methotrexate is extremely powerful and not without potential risks. If you’re on methotrexate for rheumatoid arthritis (RA), your immune response to any given infection may be reduced. I suspect the dose used in the studies was lower than that used for treating RA but even so, it wouldn’t be something you’d rush to prescribe.

It may, however, have practical application as a supplement to regular painkillers, especially for patients unsuitable for knee replacement surgery (perhaps, for example, because they are particularly young, frail, have heart, kidney or lung disease, or uncontrolled diabetes).

This, then, is an interesting case where the medication being studied may have some small impact on osteoarthritis sufferers, but the story it tells in terms of the nature of osteoarthritis is rather more far-reaching.

If you’re struggling with knee pain and want to explore treatments including knee resurfacing, please get in touch, or phone us on 03453 052 579.

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> What Is Osteoarthritis & How Do You Treat It?
> Discover more about osteoarthritis, YKC & you