Health Care

Osteoarthritis is the most common form of arthritis. It affects more than 20 million Americans according to some estimates. Because osteoarthritis (OA) is primarily a degenerative process, the incidence and prevalence of this disorder is expected to rise with the surge in Baby Boomers.

OA affects weight-bearing joints such as the knee and hip. It is a disease of articular cartilage, the tough, elastic material that cushions moving parts of joints. OA is the most common reason for eventual total hip and total knee replacement surgery.

It has been felt that early diagnosis of this condition could potentially lead to earlier treatment.

To date, treatment for osteoarthritis has centered on pain relief only. To that end oral non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin), aproxyn (Naprosyn), sulindac (Clinoril), piroxicam (Feldene), nabumetone (Relafen), etodolac (Lodine), ketoprofen (Orudis), meloxicam (Mobic), and celecoxib (Celebrex) have been used with varying degrees of success.

Along with these medicines, analgesic medicines such as acetaminophen (Tylenol), propoxyphene (Darvon), and tramadol (Ultram) have also been used to manage symptoms.

Other modalities such as physical therapy, braces, lateral wedge insoles inside shoe, arthroscopy (entering the joint with a small telescope to remove damaged and diseased tissue), injections of glucocorticoid (“cortisone”), and injections of lubricants, called viscosupplements, have also been used to alleviate symptoms.

Despite the mixed effectiveness these various treatments have had as far as pain control, they have not been completely successful.

The reason? The Holy Grail of OA treatment has been to identify treatments that can slow down and possibly reverse cartilage deterioration.

This is predicated on diagnosing the condition early. To date, diagnostic methods such as x-ray and magnetic resonance imaging (MRI) do not detect the disease until OA is in advanced stages when joint damage may already have occurred.

Arthroscopy can detect early disease but is not practical because of the invasive nature of the procedure.

A method for earlier diagnosis could open a window of opportunity for preventing or reducing permanent damage. Recent evidence suggests that dietary supplements like glucosamine/chondroitin might prevent further joint deterioration. A recent study demonstrating a new medical imaging technology may provide physicians with an accurate test for early diagnosis of OA, scientists from New York reported at the 236th National Meeting of the American Chemical Society

"Our methods have the potential of providing early warning signs for cartilage disorders like osteoarthritis, thus potentially avoiding surgery and physical therapy later on," says Alexej Jerschow, Ph.D., who reported on the research jointly with Ravinder R. Regatte, Ph.D.

He adds, "Also, the effectiveness of early preventative drug therapies can be better assessed with these methods."

Cartilage consists of collagen and proteoglycans. Proteoglycans are long chains of linked sugars and proteins.

The new method uses a modified form of magnetic resonance imaging to determine the concentration of a polymer known as glycosaminogycan (GAG), a proteoglycan that holds lots of water and gives cartilage its tough, elastic properties. GAG also is a recognized biomarker for osteoarthritis.

According to the scientists, a low concentration of GAG is known to correlate with the onset of osteoarthritis and other cartilage disorders.

The diagnostic test utilizes a method that "tags" the hydrogen atoms attached to the GAGs in a way that makes them emit a signal that can be picked up by an MRI machine to determine the concentration of GAG and assess cartilage status.

The advantage of such a test is not only to detect early OA but also to assess the effectiveness of newer disease-modifying osteoarthritis drugs (DMOADS), which are currently being studied by a number of companies.

About the Author
Nathan Wei, MD FACP FACR is a nationally known board-certified rheumatologist. For more info: Arthritis Treatment and Tendonitis Treatment Tips