A drug to treat osteoarthritis, what will they think up next? How about what are these idiots thinking, a drug to treat arthritis? So a pharmaceutical company called Medivir based out of Sweden is developing this medication. First I thought it was being created to treat pain and while that is the case it works in a way that is actually very interesting as it doesn’t work by interrupting pain like other pain medications do. As interesting as it may be, honestly I think these people are idiots going about it as they are and anyone rooting for them is an idiot as well. I know, harsh words but this whole thing seems stupid to me.
So let’s start with a definition of osteoarthritis from the Mayo Clinic’s website: “Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time.” Why we commonly refer to an osteoarthritis joint as a degenerative joint is because this processes breaks down joint tissue cartilage but it also builds more bone forming osteophytes. This process occurs as a result of increased or altered loading on the joint. When we load a joint (and not by gaining weight) beyond what it is normal for that joint over time (many years) our body will compensate by making that joint stronger. That means more bone less joint. As I said, I don’t mean increased loading due to weight gain because if weight gain did this we should see all of the joints of an obese person become arthritic as they age and this isn’t the case. In the spine it is common to see osteoarthritis at one joint surround by healthy joints. While the end result, if this process continued on long enough, would be a bony fusion of the joint. This is the body’s normal adaption to increased load or strain at a joint over a prolonged period of time.
Osteoarthritis is the product of a normal adaptive process in the body. The drug being created by Medivir works by disrupting both cartilage breakdown and bone building. Results of a preliminary trial by Medivir were discussed in an editorial in the journal Annals of Internal Medicine on December 30 2019. This is data being discussed in an editorial format printed in a journal not a formal published study which would have gone through peer review before being published. Participants in the study included 244 patients with primary knee osteoarthritis and pain score rating of 4 to 10. There was no statistically significant change in pain score between drug group and placebo group, the researchers report. Patients in both treatment and placebo group reported substantial improvement in pain and functional status, with the drug groups reporting slightly more improvement than the placebo group. What did change was significantly reduced bone growth cartilage thinning on MRI. The authors also measured sustained reductions in biomarkers of bone resorption and cartilage loss, which correlate with progression of osteoarthritis. Through the 26-week study, there were nine serious adverse events in six participants but the authors don’t believe they were related to the drug treatment.
What the researchers involved in this trial are saying is that the drug is working as they expect, reducing cartilage breakdown and bone growth at the joint. The fact that the participants still had knee pain is something they are going to further investigate. They thing that maybe the patients need to be on the drug for longer for measurable relief of pain. Something the lead author wrote in his editorial caught my eye, that the study findings do not contradict the “foundational link between modification of structure and improvement in osteoarthritis pain, but rather clarify that changes in structure do not beget immediate changes in symptoms.” Positively changing the structure might not result in immediate relief of symptoms. The link between fixing structure and symptoms isn’t as abrupt as taking a pain pill. It takes time for a joint to breakdown and it takes time for it to heal when treated. This is probably the only thing the author of this editorial, one of the studies authors gets right. Of course he is trying to justify further trials of the drug involving a longer treatment period.
What to think about this whole thing, is it a good thing that there might be a drug that basically slows or stops osteoarthritis? I say it is not a good thing for the majority of patients who have osteoarthritis and the rest of us who don’t have it. I don’t like these drugs which interrupt normal physiologic functions in the body, even when those functions result less than ideal adaptions. The most common drugs that treat osteoporosis due so by killing cells which break down old bone tissue. The issue is these patients have more of a low quality bone causing atypical site bone fractures. I have talked about this before here. How will this drug affect healthy joint tissue. Joint tissue is constantly removing old tissue and creating new tissue, will this drug interrupt this process and cause what where healthy joints become not healthy joints? If you look at other drugs like statins, statins are really good at lowering cholesterol but is this actually lowering your risk for heart disease. If this new drug can slow osteoarthritis but the patient still has pain in that joint is the drug still worth it. OR, if this drug is good at slowing osteoarthritis will doctors say we all should take is a preventative measure? This is what some doctors are saying about statins today.
This is a drug still in the clinical trials stage, not available in the open market. After reading about it I was shocked that people who know about human physiology would be excited about a drug that disrupts it despite having no affect on symptoms. The real fix for osteoarthritis is not getting it in the first place. Take care of your body, use proper biomechanics to move, to work, and at play. Keep your muscles strong and stay flexible. In the spine observe your posture, maintain good posture. If you don’t have good posture see a chiropractor that specializes in fixing it, like us.