To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: EULAR: New Concepts Of Osteoarthritis Pathogenesis And Management Guidelines URL: http://www.pslgroup.com/dg/1FE182.htm Doctor's Guide June 14, 2001
By Thomas Buckingham
PRAGUE, CZECH REPUBLIC -- June 14, 2001 -- New concepts in the pathogenesis and management of osteoarthritis were reviewed by Prof. R. W. Moskowitz of Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, yesterday at the annual meeting of the European League Against Rheumatism (EULAR) in Prague yesterday.
Osteoarthritis occurs because of an imbalance between the synthesis and catabolic processes. Proteolytic and calagenolytic enzymes destroy cartilage and inflammation increases as the process continues. With age, there is increased formation of advanced glycation end products (AGEs), which results in increased cross-linking of cartilage matrix and activation of cytokines. Specific genetic defects in type II collagen have been described.
Pain in osteoarthritis is multifactorial and includes both inflammatory and non-inflammatory components. Management is targeted at the pain, improving function and at some of the factors mentioned above.
Treatment options are simple analgesics, cyclooxigenase 2 (COX-2)-selective nonsteroidal anti-inflammatory drugs (NSAIDs), traditional NSAIDs, and occasionally, opiates, Dr. Moskowitz said.
Hyaluronan (hyaluronic acid), administered intra-articularly, leads to pain relief for long periods of time and repeat therapy is possible. This is very beneficial in patients who do not tolerate NSAIDs.
Nutraceuticals, such as glucosamine and chondroitin sulfate, have been shown to relieve pain in a number of studies and modify the pathophysiology of the disease. Agents which inhibit enzymatic or cytokine-induced breakdown or which promote matrix synthesis offer hope for the future but require further study.
Cartilage replacement with autologous chondrocytes or bone marrow stem cells also shows promise, Dr. Moskowitz concluded.
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