Cortisone Can Make Bone On Bone Worse By Thinning Out The Meniscus But One Injection Appears Okay
One of the reasons that you are considering a knee replacement or are thinking about getting a cortisone injection is because you have been told you have a bone-on-bone knee. So the idea that cortisone may make this worse by thinning out your meniscus is concerning doctors.
In August of 2020 in the journal Scientific Reports doctors expressed concerns about damaging the meniscus tissue with cortisone injections. It should be noted that this researchs main findings were that it was okay to get one cortisone injection. For many people, one injection would be considered safe. Here are the learning points of that research:
- Although intra-articular corticosteroid injections are commonly used for the treatment of knee osteoarthritis, there is controversy regarding possible side effects on the knee joint structure.
- In this study, the effects of intra-articular corticosteroid injections on worsening the knee structure and creating greater pain were examined.
- Findings: No significant effect of the intra-articular corticosteroid injections were found on the rate of cartilage loss nor on any other knee structural changes or patient-reported pain scores. In conclusion, a single intra-articular corticosteroid injection for the treatment of osteoarthritis-related knee pain was shown to be safe with no negative impact on structural changes, but there was a transient meniscal thickness reduction, a phenomenon for which the clinical relevance is at present unknown.
A Phase 2b/3a Study To Evaluate The Efficacy And Safety Of Jointstem In Patients Diagnosed As Knee Osteoarthritis
open to eligible people ages 18 years and up
This study is a double-blind, randomized, placebo controlled, multi-center, superiority study to evaluate the efficacy and safety of JointStem, autologous adipose tissue derived mesenchymal stem cells , in patients diagnosed as knee osteoarthritis. Following a 2-week screening period, approximately 140 subjects will be randomly assigned into one of the following two arms in a 1:1 ratio . After each subject completes 48-Weeks visit and the data management team confirms all individual data have no issue, the individual database will be locked and the blinding will be open for the statistical analysis.
at UCLA
Osteoarthritis Drugs In Phase 3 Clinical Trials
- Tanezumab, an antibody directed against NGF
- XS-02, oral Disodium Zoledronate Tetrahydrate
- Fasinumab, an antibody directed against NGF
- Invossa, a cell and gene therapy, intra-articular injection
- Sprifermin, FGF-18 , intra-articular injection
- Ampion, a low molecular weight fraction of human serum albumin , intra-articular injection
Additional clinical trials may be available. For a complete list of clinical trials, including eligibility information from the individual sponsors of the clinical trials, go to: www.ClinicalTrials.gov.
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Studies On Lowering Bmi Show Slowing Of Oa Incidence And Progression In Knees Risk Of Knee Replacements
Whats New Sultana Monira Hussain, PhD, senior research fellow, Chronic Disease and Ageing, at Monash University in Australia, presented research that looked at the connection between total knee arthroplasties aka total knee replacements due to OA and BMI. The team discovered that while the underlying mechanisms involved in the relationship are complex and not completely understood, a continuous increase in biomechanical loading and metabolic inflammation associated with excess adipose tissue may play a major role in disease incidence and progression.
Another study, led by Zubeyir Salis, a doctoral candidate at the Centre for Big Data Research in Health, part of the University of New South Wales in Australia, also suggested that a decrease in BMI is associated with less narrowing of the joint space on the medial but not lateral side of the knee. The medial side of the knee joint is the weight-bearing side of the knee joint, and that is likely why it is affected by weight changes, while the lateral side of the knee joint is not affected.
Research Details
Why It Matters
Weight loss has been shown to be effective at reducing pain and improving quality of life in people with knee osteoarthritis. In this study, we now show that people with overweight or obesity and potentially also those of normal weight may benefit from a decrease in BMI to prevent, delay, or slow the structural defects in knee osteoarthritis, says Salis.
Metabolic Syndrome Therapies Related To Oa
Metabolism can be altered in OA, and there are multiple metabolic components underlying metabolic dysregulation. The metabolic syndrome, characterized by excessive and long-term positive energy balance, is defined by several cardio-metabolic factors that commonly are found together with obesity, which are central adiposity, dyslipidemia, impaired fasting glucose levels, and hypertension. People with metabolic syndrome are prone to developing a variety of disorders, especially cardiovascular diseases, type 2 diabetes mellitus , and some forms of tumor. The increase in prevalence of metabolic syndrome in industrialized nations, and an association with obesity, together with the fact that it was a rare disease in pre-industrial populations, leads to the hypothesis that the metabolic syndrome might be a major risk factor for OA nowadays6,127,128.
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Are Hyaluronic Injections Low
A research letter in the Journal of the American Medical Association Internal Medicine, with the title: Are Hyaluronic injections low-value health care? Using Medicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections, backed that up withbased on high-quality evidence that hyaluronic acid injections were not associated with clinically meaningful improvement in symptoms compared with placebo injections.
This statement paper is from 2014, lets see if we can advance the research forward towards 2021.
The first stop is February 2016 and the journal Clinical Orthopaedics and Related Research. It is an editorial from Seth S. Leopold, MD. Here are the quoted learning points:
What Are The Stages Of Arthritis Of The Knee
There are five stages of osteoarthritis, the most common type of arthritis that affects your knees:
- Stage 0 . If youre at stage 0, your knees are healthy. You dont have arthritis of the knee.
- Stage 1 . Stage 1 means that youve got some wear and tear in your knee joint. You probably wont notice pain.
- Stage 2 . The mild stage is when you might start to feel pain and stiffness, but theres still enough cartilage to keep the bones from actually touching.
- Stage 3 . If youre at the moderate stage, youll have more pain, especially when running, walking, squatting, and kneeling. Youll likely notice it after long periods of rest . Youâre probably in a great deal of pain because the cartilage has narrowed even further and there are many bone spurs.
- Stage 4 . Severe osteoarthritis means that the cartilage is almost gone. Your knee is stiff, painful and possibly immobile. You might need surgery.
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How Not Using A Treatment Registry May Blow Up Your Practice
This week I got a call from a medical provider who is being investigated by his state attorney general over a dissatisfied patient. IMHO that provider is at higher risk because he didnt use a treatment registry. So lets dig into why not tracking your outcomes when using interventional orthobiologics may risk your entire practice.
Knee Replacement Alternatives To Consider
Crunching sounds as you climb stairs, chronic aching and swelling: Knee osteoarthritis is a real pain. If youre suffering with it, you may be considering surgery.
Getting a knee replacement is one approach, but you may not need surgery, at least not right away. And some patients cannot undergo knee replacement surgery for various reasons. Other people with knee pain are too young for a knee replacement the artificial knee is only likely to last 15 or 20 years, after which the person may need revision surgery.
There are several things you can try first, on your own or with a professionals help, that can help with knee pain and even delay the need for replacement.
Arthritis doesnt go away, but there are things you can do to lessen the pain and stay more active.
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Combining An Injection Of Hyaluronic Acid And Dextrose
An April 2022 paper in the Archives of Physical Medicine and Rehabilitation wrote: Compared with hyaluronic acid plus normal saline co-injections, hyaluronic acid plus dextrose co-injections resulted in more significant improvements in stair-climbing time and physical function at six months, effectively decreased pain, and improved physical function and physical functional performance from 1 week to six months. Hyaluronic acid plus dextrose co-injections could be a suitable adjuvant therapy for patients with knee osteoarthritis.
Prp Is Not A Single Shot Miracle Cure The Effectiveness Of Prp Is In How Many Times The Treatment Is Given
PRP is not a single shot miracle cure. While for the rare patient a single shot may work for them, we have seen in our clinical experience, that PRP not to be as effective as a stand-alone, single-shot treatment. When someone contacts our center with a question about PRP, they understand the concept and that it should have helped them. But it did not. Why?
PRP does not work for every patient. The two main reasons are that some knees are indeed too far gone. What is typically too far gone? A knee that does not bend anymore or there is significant structural changes like bone spurs that have fused the knee.
The second reason is that they did not allow the treatment a chance to work. Many people think they are supposed to get immediate relief. That is not how PRP works.
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The Navio Cori Surgical Systems
Navio Cori is a computer-guided robot designed for orthopaedic surgery. It is built with open-source hardware and software components to provide surgical benefits. In human body, it targets specific soft tissue anatomy like medial femoral condyle. This robot allows precise robotic drilling of bony surface preparation with millimeter accuracy. Ensuring more effective procedures and better clinical outcomes. these benefits were not available in any other medical device.
A Mako system has a slight difference from Navio. The Mako robot utilizes specific scans for the knee before surgery to get proper measurements. The patients who have opted for traditional knee replacement can also opt for robotic knee replacement. This surgery is ideal even for high complex joint diseases. This involves patients who have:
A Cure On The Horizon
The study uncovered “high-value drug targets” for potential treatments. A so-called drug target is a molecule in the body that is linked to the way a disease process plays out, and could be altered using a drug. Such targets are important in helping to stop disease progression in the body.
The researchers were able to identify these targets by pinpointing genes that were likely the cause for osteoarthritis.
Many of these genes signify molecules that are the targets of existing approved drugs and drugs that are currently in clinical development.
“We have confidently identified 100 different genetic risk variants changes in the DNA sequence for osteoarthritis, 52 of which had not been associated with the disease before,” said Eleftheria Zeggini, director of the Institute of Translational Genomics at the Helmholtz Center in Munich.
Their findings provide more evidence that multiple drugs in development are on the right track, as well as point to new ways existing drugs could be used to help osteoarthritis sufferers, Zeggini told DW.
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Patient Observational Pain And Activity Survey Study Using Rs
Sorry, not yet accepting patients
Spine pain and joint pain are among the most common worldwide ailments and directly contributes to disability as well as increased duration of care. Spine and joint pain affect work sick leave, production and increased financial costs to healthcare. Non-invasive treatments for spine and joint pain can vary widely from lifestyle changes, physical therapy, oral medication, and select medical devices, that can improve pain level and help improve the quality of life of individuals. Thus, the general population suffers from an ailment that has multiple conservative treatment options with variable outcomes. Transcutaneous Electrical Neuromuscular Stimulation has been show to decrease pain and restore function. Interferential therapy is a specific signal type that is effective for reducing musculoskeletal pain. Neuromuscular Electrical Stimulation uses a specific signal type to cause muscles to contract and therefore provide functional improvement. The RS-4i Plus is an FDA-regulated prescription TENS medical device that outputs an INF signal and a NMES signal, and a unique Intersperse signal, which combines NMES and INF into a single treatment. Therefore, the goal of this study is to determine if use of the prescribed RS-4i Plus in patients presenting with pain, axial or peripheral joint, can be efficacious in decreasing the patient’s pain and improving their activity measured at one month, three months, and six months of use.
at UC Irvine
What Is Osteoarthritis Of The Knee
Osteoarthritis of the knee happens when the cartilage in your knee joint breaks down, enabling the bones to rub together. The friction makes your knees hurt, become stiff and sometimes swell. While osteoarthritis in the knee cant be cured, there are many treatments to slow its progress and ease your symptoms. Surgery is an option for more severe forms of osteoarthritis.
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Laser Therapeutic Ultrasound And Electrical Stimulation
The OARSI guidelines strongly recommended against the use of laser therapy for knee OA, citing an implausible biological mechanism and no efficacy, with a very low overall quality of evidence.8 The potential mechanisms of pain relief by laser therapy are due to the stimulus of tissue metabolism and modulation of the inflammatory process. However, literature shows contrasting evidence regarding the use of laser therapies, more specifically low-level laser therapy , in treating individuals with knee OA. A meta-analysis evaluating the effectiveness of LLLT on symptoms and function in patients with knee OA, showed no therapeutic benefit of LLLT compared with placebo for patients.58 A more recent meta-analysis showed that LLLT seems to reduce pain and disability in individuals with knee OA when compared to placebo in randomized controlled trials.59
Studies regarding therapeutic ultrasound, although reporting beneficial effects of the therapy for knee OA, show methodological limitations that hinder the evidence synthesis, such as the inclusion of mixed interventions.60, 61, 62, 63, 64 Thus, there is low quality of evidence to support the use of therapeutic ultrasound for individuals with knee OA.8 However, the ACR guidelines conditionally recommends its use , meaning that therapists need to give a complete and clear explanation of benefits, harms, and burdens of the treatment when presenting it as an option to a patient.13
Who Should Get This
Not everybody is a good candidate for this procedure. UCLA Health says the ideal patients are people ages 40 and 80, have moderate to severe localized knee pain and did not benefit from other therapies.
Sethi told Healthline that though this is a great option for older people who cannot tolerate surgery, more research may be needed to verify these findings.
We definitely need larger and randomized controlled studies to help us understand the true impact of embolization. However, this seems like a relatively safe and non-invasive option for non-surgical patients who are looking for additional options, said Sethi.
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How Is Oa Treated
There is no cure for OA, so doctors usually treat OA symptoms with a combination of therapies, which may include the following:
- Increasing physical activity
- Medications, including over-the-counter pain relievers and prescription drugs
- Supportive devices such as crutches or canes
In addition to these treatments, people can gain confidence in managing their OA with self-management strategies. These strategies help reduce pain and disability so people with osteoarthritis can pursue the activities that are important to them. These five simple and effective arthritis management strategies can help.
Physical Activity for Arthritis
Some people are concerned that physical activity will make their arthritis worse, but joint-friendly physical activity can actually improve arthritis pain, function, and quality of life.
How Can I Manage Oa And Improve My Quality Of Life
CDCs Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms.
- Learn self-management skills. Join a self-management education class, which helps people with arthritis and other chronic conditionsincluding OAunderstand how arthritis affects their lives and increase their confidence in controlling their symptoms and living well. Learn more about the CDC-recommended self-management education programs.
- Get physically active. Experts recommend that adults engage in 150 minutes per week of at least moderate physical activity. Every minute of activity counts, and any activity is better than none. Moderate, low impact activities recommended include walking, swimming, or biking. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease, stroke, and diabetes. Learn more about physical activity for arthritis.
- Go to effective physical activity programs. For people who worry that physical activity may make OA worse or are unsure how to exercise safely, participation in physical activity programs can help reduce pain and disability related to arthritis and improve mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help people with OA feel better. Learn more about CDC-recommended physical activity programs.
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Grinding And Grating With Knee Arthritis
The sensation of grinding and grating is caused by the unsmooth bones in the joint rubbing against each other. It is also known as crepitus and most commonly felt under the kneecap during weight-bearing activities.
The kneecap is more affected than other parts of the knee joint due to muscle tension or previous injuries causing it to misalignment and track outside of the groove that it is supposed to sit it.
This eventually leads to friction and wearing of the cartilage on the underside of the kneecap.
Some individuals experience grinding and grating, but have no joint pain at all.
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