‘Appreciating neuroplasticity’ may be key to developing effective osteoarthritis therapies
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SAN DIEGO — The key to developing effective therapies for the management of osteoarthritis may lie in appreciating neuroplasticity in patients with the disease, according to a speaker at the Congress of Clinical Rheumatology West.
“It is really important to appreciate the tremendous neuroplasticity that has occurred in joints with osteoarthritis, because it was previously unappreciated, and we really have to understand that fact in that context if we are going to develop new treatments,” Ann-Marie Malfait, MD, the George W. Stuppy, MD, chair of arthritis at Rush Medical College, in Chicago, told attendees.
According to Malfait, there may also be potential therapeutic treatments in neutralizing antibodies to nerve growth factors.
Meanwhile, exercise and physical therapy have been emphasized in recently updated guidelines for OA management, and current therapeutic practices, such as treatment with acetaminophen or NSAIDs, result in low levels of effect or fleeting relief, as seen in patients who are prescribed opioids, she added.
“All patients should exercise,” Malfait said. “There is very strong evidence that exercise is very good for patients with osteoarthritis. Physical therapy is emphasized, as well as nontraumatic Eastern disciplines such as tai chi and yoga.”
However, complete joint replacement remains the most impactful treatment.
“Ultimately, joint replacement, for the larger joints, is still considered a definitive treatment,” and is successful in approximately 70% to 80% of patients, Malfait said.
Meanwhile, nerve growth factor blockades remain a promising avenue, but the side effects of rapidly progressive osteoarthritis need to be understood, she added.
According to Malfait, neutralizing antibodies to nerve growth factors have offered some hope in phase 3 trials conducted in 2010, but concerning adverse events, including rapidly progressive OA in a “not insignificant portion of patients,” caused the FDA to pause all trials.
Specifically, tanezumab (Eli Lilly, Pfizer), was not approved for OA by the FDA in 2021, which cited an unacceptable risk of joint destruction due to rapidly progressive OA.
Rather, current management strategies for osteoarthritis are limited and are mostly focused on “pain and function,” Malfait said.
“There are no approved disease-modifying drugs for osteoarthritis, and the pipeline is currently still very thin,” she added.
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Malfait AM. Osteoarthritis: What's new in 2022? Presented at: The Congress of Clinical Rheumatology West; Oct. 20-23, 2022 (hybrid meeting).
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