Category Archives: Arthritis

Genicular Artery Embolization: A Promising Therapy for Pain Relief from Knee Arthritis

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PainRelief.com Interview with:
Dr. Siddharth A. Padia, MD
Interventional Radiology
Ronald Reagan UCLA Medical Center
UCLA Santa Monica Medical Center

Dr. Padia, MD

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis (OA) of the knee can be a debilitating condition with significant impact on a person’s overall quality of life. OA has historically been considered a “wear-and-tear” disease, resulting from years of stress induced cartilage degeneration. Recent data suggests that inflammation plays a role not only in the experience of pain secondary to osteoarthritis, but is a driver of OA itself. 

Genicular artery embolization (GAE) is a minimally invasive procedure where the arteries supplying the lining of the knee are selectively catheterized during an angiogram to target abnormally increased blood flow associated with knee osteoarthritis. Injection of small, microspheres results in a reduction in arterial flow, which may in turn reduce the synovial inflammation. 

PainRelief.com: What are the main findings?

Response: 40 subjects were enrolled in this trial. Technical success was achieved in 100% of subjects. Transient skin discoloration and transient mild post-procedure knee pain were common and expected. Pain scores decreased from a 8 (out of 10) at baseline to 3/10 (63% decrease) at 12 months. Twenty-seven patients (67.5%) had greater than a 50% reduction in pain scores. 

PainRelief.com: What should readers take away from your report?

Response: Genicular artery embolization is a highly promising therapy for people with knee arthritis, who are not surgical candidates or which to defer surgery. It is the first non-surgical treatment that has shown to have a significant reduction in pain with a duration of at least one year. It is minimally invasive, and most people can resume their everyday activities the evening after their procedure. 

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: This was a single arm trial, in that genicular artery embolization was not compared to other treatments. Future research needs to show a comparison to other treatments or placebo in order to prove its efficacy. Additionally, long-term result (2 and 4 years) would be beneficial to show the durability of GAE over time. 

Citation:

Abstract No. 16 Genicular artery embolization for the treatment of knee osteoarthritis: final results from a prospective investigational device exemption trial
Padia, S. et al. Journal of Vascular and Interventional Radiology, Volume 32, Issue 5, S8

https://www.jvir.org/article/S1051-0443(18)31829-3/fulltext

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Fusion vs Replacement for Pain Relief from Ankle Arthritis

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PainRelief.com Interview with:
Bruce J. Sangeorzan, M.D., Professor
Director, RR&D Center for Excellence in Limb Loss Prevention and Prosthetic Engineering
Veterans Affairs
University of Washington

PainRelief.com:  What is the background for this study?

Response: We began a series of studies in the early 2000’s when ankle replacement was limited to a few centers like our own. We knew that ankle arthrodesis– or fusion—was an effective treatment for ankle arthritis. But ankle fusion is not appropriate for some people and it also results in loss of ankle motion. There were a growing number of ankle replacements being done but little was known about their effectiveness or how long they last.

We wanted to study whether replacement and fusion were comparable for pain relief and activity and wanted to know if maintaining motion of the ankle (by using a replacement) would have an advantage without additional risk. Three studies were done involving more than 800 patients from 6 centers.

This most recent study compared two groups of patients who had similar amount of pain and activity before treatment. All of the patients had already tried non -surgical solutions such as activity modification, bracing and injections with out improvement. One group had fusion of the ankle and the other had replacement of the ankle. Patients were questioned and examined four years or more after surgery and compared to their condition before treatment.

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Do NSAIDs Accelerate Progression of Knee Osteoarthritis?

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PainRelief.com Interview with:
Dr Thomas Perry PhD| Postdoctoral Research Fellow
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research 
Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences

Dr Thomas Perry PhD| Postdoctoral Research Fellow Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences
Dr. Perry

PainRelief.com:  What is the background for this study?

Response: Management of knee osteoarthritis (OA) is multi-factorial and routinely involves the use pharmacological interventions; with most medications aimed at alleviating painful symptoms and improving function.

Little is known of the long-term effects of such medications on the structural progression of radiographic knee OA. Through examining the relationship between pharmacological interventions and the disease pathway, this may, in turn, identify potential areas for disease-modifying treatment development.

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Hand Arthritis: Supplement Did Not Provide Pain Relief

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PainRelief.com Interview with:
Xiaoqian Liu
Clinical research fellow (Wednesday/Thursday)
Rheumatology Department| Royal North Shore Hospital
Institute of Bone and Joint Research | Sydney Medical School

hand arthritis

PainRelief.com:  What is the background for this study?

Response: Hand osteoarthritis (HOA) is a prevalent joint disease, causing symptoms in up to 10% of the general adult population worldwide. Hand pain is the most common symptom in addition to functional disability and decreased quality of life. Due to the modest effects and/or potential harms, current traditional treatment such as exercise, non-inflammatories and analgesics frequently do not meet patients’ demand. More and more people are turning to complementary and alternative medicines for pain relief.

In our previous work, we identified four dietary supplements with promising treatment effects for relieving pain which are Boswellia serrata extract, curcumin, pine bark extract and methylsulfonylmethane (MSM). The hypothesis was that combining these supplements to generate an enhanced benefit for people with HOA. The aim of the RADIANT study was to investigate the efficacy and safety of a 12-week course of this supplement combination in people with painful HOA who were confirmed with the diagnosis on their hand x-ray.

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High and Low Intensity Weight Training May Reduce Pain From Knee Osteoarthritis

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PainRelief.com Interview with:
Stephen P. Messier, PhD
.B. Snow Biomechanics Laboratory
Department of Health and Exercise Science
Wake Forest University
Winston-Salem, North Carolina

Stephen P. Messier, PhD .B. Snow Biomechanics Laboratory Department of Health and Exercise Science Wake Forest University Winston-Salem, North Carolina
Dr. Messier

PainRelief.com:  What is the background for this study?  What are the main findings?

Response: Thigh muscle weakness is associated with knee discomfort and osteoarthritis disease progression. Little is known about the efficacy of high-intensity strength training in patients with knee osteoarthritis and whether it may worsen symptoms.

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Challenges in Providing Osteoarthritis Pain Relief

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PainRelief.com Interview with:
Rebecca L Robinson
Patient Outcomes and Real-World Evidence
Eli Lilly and Company, Indianapolis, IN

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis (OA) pain is unfortunately common and greatly affects patients’ quality of life. Treatment varies from patient to patient and can include nonpharmacologic therapies, over-the-counter (OTC) and prescription pain medications, as well as surgery. The combination of these treatment modalities and especially the use of acetaminophen, NSAIDs or opioids in OA patients has not been examined thoroughly. This study helps to address this gap while also demonstrating variations in treatment received by patients with different levels of pain severity. We analyzed data from the United States OA Adelphi Disease Specific Programme (DSP), which links patient and physician perspectives on the management of OA via cross-sectional surveys.

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Guided Radiofrequency Ablation Can Provide Pain Relief for Patients with Moderate to Severe Osteoarthritis of the Shoulder and Hip

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PainRelief.com Interview with:
Felix M. Gonzalez, M.D.
Radiology Department at Emory University School of Medicine
Atlanta, Georgia

PainRelief.com: What is the background for this study? What are the main findings?

Response: Arthritis afflicts 30 million Americans yearly with the most common form being degenerative arthritis. The main joints affected are the knee, hip and shoulder joints.  

Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention. The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion. People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks: Prolonged use is linked to increased risks of heart disease and kidney damage. Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time and there are long-term safety issues, including a risk of cartilage damage.  

Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections — two standard treatments — were no longer helping.  

Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.  

In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average. Among hip arthritis patients, pain declined by an average of 70%. 

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Orthopedic Surgeon Discusses iovera Cold Therapy For Pain Relief from Knee Osteoarthritis

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PainRelief.com Interview with:
Dr. Sean McMillan DO
Chief of Orthopedics and Director of Orthopedic Sports Medicine
Lourdes Medical Center of Burlington County, Burlington, NJ
Assistant Professor of Orthopedic Surgery at Rowan University –
School of Osteopathic Medicine

Dr. McMillan discusses the iovera° system which is used to provide pain relief from knee osteoarthritis, using extreme cold therapy.


PainRelief.com:  What is the background for this procedure?

Response: I see many patients dealing with osteoarthritis (OA) pain, many of whom need total knee replacements. In fact, OA is the most common joint disorder in the United States and one of the primary reasons people seek knee replacement surgery. iovera° is a non-opioid, nonpharmacologic treatment that can alleviate knee pain by delivering extreme cold therapy (cryoanalgesia) to a targeted nerve. The iovera° treatment uses the body’s natural response to cold to treat nerves and immediately reduce pain for patients dealing with OA and/or surgical pain from knee replacement procedures. One treatment with the iovera° system can provide pain relief for up to 90 days.

Unaddressed knee pain can have many consequences such as increased discomfort, reduced mobility, and irreversible damage. This non-opioid treatment helps to stave off pain both prior to surgery and for postsurgical pain when surgery becomes necessary, making for a smoother recovery process with limited opioid use.

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Voltaren® Arthritis Pain Provided Meaningful Pain Relief in Knee Osteoarthritis

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PainRelief.com Interview with:

Jeffrey Fudin, B.S., Pharm.D., FCCP, FASHP
Diplomate, American Academy of Pain Management
Section Editor, Pain Medicine

Dr. Fudin

PainRelief.com:  What is the background for this study?

Response: Osteoarthritis (OA) affects over 14% of the United States population. As such it is important to establish effective, well-tolerated, and safe medication options. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) act locally and are strongly recommended for patients with knee osteoarthritis as a first line option prior to chronic oral NSAID use in an effort to minimize systemic exposure, as oral products, result in tremendously higher blood levels compared to their topical counterpart.

PainRelief.com: What are the main findings?

Response: Diclofenac sodium gel 1% (DSG 1%), a topical NSAID, provided better pain relief than non-drug vehicle alone for patients with knee osteoarthritis in 3 clinical trials. A post-hoc meta-analysis of these trials was conducted to determine the percentage of patients achieving a minimal clinically important improvement (MCII) in pain and other symptoms of OA to gain insight into the real world clinical impact of topical diclofenac for patients. The MCII is defined as the smallest improvement in symptoms viewed as clinically meaningful for patients. In short, the MCII represents an improvement of relevance in a clinical trial and the minimal meaningful change at an individual level.

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Newly Discovered Molecule Causes Pain Relief and Cartilage Healing in Osteoarthritis

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PainRelief.com Interview with:
Prof Francesco Dell’Accio and
Dr Suzanne E Eldridge
Department of Experimental Medicine and Rheumatology
William Harvey Research Institute
Barts and The London, Queen Mary’s School of Medicine and Dentistry,
London

PainRelief.com:  What is the background for this study?

Response: Our main research focus is osteoarthritis. Osteoarthritis is the most common form of arthritis, affecting 10-30% of the population over the age of 60, causing joint pain and disability for many. In osteoarthritis, the cartilage that covers the bones in the joints is destroyed. Therefore, the bones grind over each other, causing pain and disability. Joint replacement surgery is often carried out.  

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