Highlights from ACR 2020: The Future of Osteoarthritis Treatment & Research

Osteoarthritis (OA) is the most prevalent form of arthritis, affecting more than 30 million adults in the Unites States. The Arthritis Foundation is transforming the landscape of treatments and advancing OA science by gathering the top clinical research scientists and experts in the field through our OA Clinical Studies (OACS) program.

As the Foundation’s Director of the Osteoarthritis Programs, I have had the distinct pleasure of working side-by-side with the leaders in the OA research and science community through our OACS program, many of whom recently participated in the 2020 American College of Rheumatology (ACR) virtual conference, sharing the latest in OA research. Many of the Arthritis Foundation funded researchers participated in this year’s annual meeting as well.

Here are some of the highlights from sessions I attended to learn the latest treatments and research that is underway in osteoarthritis.

Mechanisms for Pain Activation in OA and the Anti-NGF Treatments
A hot topic in OA is how to manage the pain OA without the use of opioids. One potential treatment being explored is the use of inhibitors for nerve growth-factor (NGF). Richard Loeser, MD, of University of North Carolina at Chapel Hill, is a current Arthritis Foundation funded awardee and moderated this session. The discussion looked at this important new class of pain therapy targeting NGF receptors in the joint for osteoarthritis pain.

Currently, the Federal Drug Administration (FDA) is evaluating tanezumab, an NGF-inhibitor drug that works by interrupting the pain signal from reaching the spinal cord or brain. This could potentially become the first alternative to opioid analgesics for severe OA pain. This would be especially critical for patients who want to avoid becoming one of the 11.5 million Americans who are addicted to opioids to manage their pain.

Professor David Hunter, MD/PhD, of the University of Sydney in Australia, describes NGF inhibitors as “a novel agent, providing a unique pathway where a substantial portion of people who receive the drug get a considerable pain relief response” as well as being useful to “people who still have disabling pain despite exercise, weight loss, assistive devices and simple analgesics like anti-inflammatories.”

Camilla Svensson, PhD/MSc, from Karolinska Institute, believes that anti-NGF therapy can also have a significant role in autoimmune arthritis, with research showing NGF being detected in joints of autoimmune arthritis models as well.

But, this new class of drug has important safety considerations.  Professor David Walsh, PhD/FRCP, of the University of Nottingham overviewed the mechanism of OA pain and reported at ACR that “Tanezumab is associated with reduced OA pain at 16 weeks and increased joint safety events through week 52.”

He also stated that “Tanezumab consistently reduced OA pain across clinical trials.”

Previously, Professor Walsh presented similarly at an OACS Forum Series session earlier this year, “Tanezumab and Similar Emerging Therapies”. During the forum he also commented about “Risk mitigation strategies in OA patients who do not receive pain relief.” Click here to watch more from this OACS forum program.

Farsh Guilak, PhD, a member of the Arthritis Foundation Medical Science Advisory Board, weighed in on the latest research. “NGF inhibitors appear to have excellent potential for reducing pain in OA.  As we learn more about the exact mechanisms by which NGF and nerves control, not only pain but overall joint health, we can hopefully identify and greatly reduce the risk factors that lead to rapidly progressive OA, especially with the development of new drugs that only target specific aspects of the NGF pathway.”

Metabolic and Crystal Arthropathies Poster
Another session highlighted research with the use of imaging when evaluating joint damage with knee osteoarthritis (OA). Professor Tuhina Neogi, MD/PhD/FRCPC, from Boston University School of Medicine shared research comparing the use of computed tomography (CT) scans to traditional x-rays to detect intra-articular mineralization in older adults with at-risk knee OA. Results showed that CT scans appeared to be more sensitive than the traditional x-rays for detecting arising issues of OA. This may be an interesting, improved imaging modality to monitor OA progression to further explore and better treat OA.

Dr. Neogi was a presenter and panelist in the October OACS Forum Series, “The Role of MRI in OA Clinical Research”. Watch the forum discussion here.

Epidemiology and Public Health Poster Session: OA, Osteoporosis, and Other Rheumatic Diseases
Physical therapy plays an important role in the treatment and management of osteoarthritis. One session discussed the role muscle strengthening plays in the management of OA.

“Weaker hip abductor strength was associated with new onset and worsening knee pain in females, but not in males,” said Cara Lewis, PhD, Associate Professor at Boston University School of Medicine. “The challenge is that addressing hip abductor weakness, by strengthening, doesn’t always change pain.”

Lewis says this may suggest that physical therapists should focus on their patients both gaining strength and using the gained strength during daily activities. This idea fits the “use it or lose it” philosophy. She reports the relation of abductor strength with knee pain appears to be substantially due to its association with quadriceps strength.

Hear more about the role of strength in OA by viewing our June OACS Forum Series recording, “Does Strong Muscle Matter in OA?

Neuropathic Pain in Inflammatory Hand Osteoarthritis (OA) Lowers Quality of Life and May Require Another Approach Than Anti-inflammatory Treatment
Many people suffer from the pain of osteoarthritis (OA) in the hand, with little relief and minimal effective treatments. Several research results were shared in a session focused on treating neuropathic pain in inflammatory hand OA to improve quality of life. Researchers are exploring alternative approaches to treating OA hand pain besides anti-inflammatory treatments.

Leiden University Medical Center’s Dr. Coen van der Meulen, MSc shared research results, saying, “This study gives us new leads that investigate the nature of their pain. More detailed knowledge of the nature of pain in hand OA may in turn be used in future research to improve treatment options. We place a lot of importance on finding a better treatment for these symptoms, since we know how much quality of life they can cost.”

This research may help to open the doors to new and better treatments for hand OA.

Dr. Margreet Kloppenburg, Leiden University Medical Center (LUMC), one of the lead researchers for this study, also recently presented at the Foundation’s OACS Forum Series. She says their research “study indicates the diversity of pain subtypes seen in hand OA, including neuropathic-like pain.” These researchers believe their “study seems to indicate that different types of pain exist separately in patients with hand OA, and that they may require different types of treatment.”

Both Dr. Kloppenburg and Dr. van der Meulen think further studies are warranted to increase insight in the presence of pain subtypes in patients with hand OA and which treatments are most effective for the different subtypes of pain. Much more research needs to be done in this area.

Dr. Lotte van de Stadt, also part of this LUMC research study adds “We feel that these neuropathic pain-like symptoms warrant a great deal of attention in the upcoming years, so that we may better understand hand OA and ultimately move towards improving treatment for our patients.’

Many of these topics above were recently discussed as part of the ongoing OACS Forum Series  and during the 2020 OACS Online Conference program in December. The Arthritis Foundation will continue convening discussions as it relates to advancing OA research through these forums in 2021 to advance the mission to conquer arthritis.

-JASON KIM, DIRECTOR OF OSTEOARTHRITIS PROGRAMS

 

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