Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

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

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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

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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