What does the future hold for the treatment of osteoarthritis?

Osteoarthritis (OA) is a degenerative joint disease that affects millions of people worldwide. While most current treatments focus on managing symptoms like pain and inflammation, future treatments aim at slowing, stopping, or even reversing the disease progression. There are many new treatments that will begin to be available in the near future. One of these is stem cells that have the potential to regenerate damaged cartilage and reduce inflammation. Mesenchymal stem cells (MSCs), derived from bone marrow, fat tissue, or umbilical cord, are being studied for their ability to promote cartilage repair and reduce OA symptoms. Clinical trials are underway to evaluate their long-term efficacy and safety. Platelet-Rich Plasma (PRP) involves injecting concentrated platelets from the patient's blood into the joint, which may stimulate cartilage repair and reduce inflammation. It is already in limited use for OA, but more research is being done to optimize its application and understand its long-term effects. Gene therapy is another prospect that aims to modify the patient’s genetic material to promote the production of proteins that protect cartilage or reduce inflammation. Research is ongoing to identify specific genes that can be targeted to slow or stop the progression of OA. Some of the newer disease-modifying osteoarthritis medicines (DMOADs) are showing promise. DMOADs are being developed to not just manage OA symptoms but to alter the disease process itself. They aim to protect cartilage, reduce degradation, and potentially regenerate damaged joint tissues. Some promising candidates include Tanezumab which is a monoclonal antibody that blocks the nerve growth factor (NGF), which is involved in pain signaling. It’s being tested as a new approach to pain relief in OA without relying on NSAIDs. Another are the matrix metalloproteinase (MMP) inhibitors. MMPs are enzymes that break down collagen and cartilage. Inhibiting these enzymes may slow cartilage degradation in OA. Another potential DMOAD is SM04690 (Lorecivivint) which is a small-molecule pathway inhibitor has been shown to reduce inflammation, inhibit cartilage breakdown, and promote cartilage regeneration in clinical trials.

Biologic therapies, such as monoclonal antibodies or proteins, target specific pathways involved in OA progression. Some examples include interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) inhibitors. Cytokines are involved in inflammation, and these block their activity could reduce joint inflammation and cartilage damage. Fasinumab, like tanezumab, targets NGF to reduce pain without affecting opioid receptors. 3D bioprinting and cartilage engineering involves using 3D printers to produce custom cartilage implants from a patient’s own cells or biomaterials. Research is focusing on developing inserts that can replace damaged cartilage in OA joints and restore function. Hydrogels and scaffolds are used to support cartilage regeneration. Hydrogels can be injected into the joint, where they harden and provide a scaffold for new cartilage cells to grow. Combined with growth factors or stem cells, these materials could promote healing. Nanoparticles can also be engineered to deliver drugs or growth factors directly to the joint in a more targeted and efficient manner. This allows for reduced side effects and more effective treatment. Current research is exploring nanoparticles for cartilage repair and drug delivery in OA. Also coming are senolytic medicines that target and eliminate senescent cells, which accumulate in OA joints and contribute to inflammation and tissue degeneration. By removing these "aging" cells, senolytics could potentially slow down or reverse the progression of OA.

On the surgical front, there are advances in robotic and arthroscopic techniques that are improving the accuracy and outcomes of joint replacement surgeries for osteoarthritis. This reduces recovery time and improves the longevity of implants. Advances in imaging and manufacturing allow for joint replacements tailored to an individual’s anatomy. These personalized implants may improve joint function and reduce the risk of complications.

Emerging evidence suggests that the gut microbiome may influence joint health and inflammation. Probiotics or dietary interventions that improve gut health could potentially reduce systemic inflammation and slow the progression of OA.. Despite the long history of osteoarthritis, the future of osteoarthritis treatment is promising, with many therapies moving beyond symptom management toward disease modification, tissue regeneration, and personalized medicine. These advancements could potentially revolutionize how OA is treated, offering patients more effective and long-lasting solutions. While some of these treatments are in early stages, others are already in clinical trials and may be available in the near future.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.