Osteoarthritis (OA) is the most common form of arthritis and is one of the top 10 conditions that contribute to the number of years lived with a disability – a measure that reflects the impact a disease has on quality of life before it disappears or leads to death. To date, no treatments have been approved that slow the progression of the disease. The development of treatments has been frustrating in part because animal models of disease caused by joint trauma poorly reflect the human disease, which usually occurs over many years and without prior trauma.
Researchers from Boston University Chobanian & Avedisian School of Medicine now propose to study individuals after they suffer knee trauma, such as anterior cruciate ligament (ACL) tears.
“Given the repeated, expensive, and discouraging past failures in developing effective treatments for osteoarthritis, a new approach is needed that focuses research for effective treatments on people with early disease,” said corresponding author David T. Felson , MD, MPH, professor of medicine and epidemiology at the School of Medicine and Boston University School of Public Health.
While most patients recover after sustaining a serious joint injury, such as an ACL tear, some experience persistent pain and develop osteoarthritis. Felson suggests that sufficient numbers of such patients exist and can be identified in advance to form a risk group in which treatments to prevent disease can be tested.
Current treatment options that reduce joint pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), are successful in some patients, but their use is limited by their toxicity. Exercise or weight loss are effective, but long-term compliance is poor. The number of total knee replacement surgeries is rising rapidly, indicating that nonsurgical treatments have not successfully alleviated patients’ pain and disability.
Researchers from BU and Cleveland Clinic reviewed data from the MOON (Multicenter Orthopedic Outcomes Network) cohort, a group of 2,340 individuals who underwent ACL reconstruction (ACLR) after traumatic tears. The MOON researchers reported that 26% of ACL reconstruction patients who responded had at least moderate knee pain with daily activities, especially climbing stairs and walking. They also found that 16.6% had a KOOS (Knee Injury and Osteoarthritis Outcome Score) pain score of less than 80 (scale 0-100 with 100 being no pain), indicating that mild to moderate pain is not rare after ACLR.
By using the MOON risk factors – which include pain and structural changes in all joint tissues, especially cartilage loss – to select individuals at high risk for subsequent pain, they were able to create a cohort at high risk for substantial post-ACLR pain . “This approach offers the potential to prevent disease and is especially valuable in targeting young adults who, following a knee injury, may have significant joint pain and disability for years before they are considered for joint replacement,” he adds.
These findings appear online in the Annals of the rheumatic diseases.
Funding for this study was provided by the Arthritis Foundation and by the National Institutes of Health (NIH P30 AR072571).
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