This drug will worsen your arthritis, this isn’t a click-bait title if the research shows it is true, right? So recent studies of this drug Tanezumab shows some effectiveness in reducing pain related to osteoarthritis in the knee but with a catch. These studies also indicate that patients taking this drug experienced a rapid worsening of their arthritic joints. That sounds like a problem to me.
Tanezumab is a drug developed in 2006 to treat pain. Of course what it really does is mask pain. The only way to treat pain is to treat the cause of pain not disrupt the transmission of pain through the nervous system which is how this drug works. This is a drug that blocks the function of our nerves. It has been examined for use with patients with pain due to osteoarthritis of the knee dating back to 2009 and more recently osteoarthritis of the hip (2013) and lower back (Feb 2019). Other uses include treating pain due to bone cancer and bladder pain syndrome also know as interstitial cystitis.
What caught my eye is the results of a recent study which confirmed findings of previous studies on this drug. This study involved 696 patients with osteoarthritis of the knee or hip. They were divided into three groups; two revived different doses of the drug and the third got a placebo. The results showed a modest improvement in pain in the groups who were given the drug over the placebo. The results also showed that the patients who were given the drug had a rapid deterioration of their arthritic joints where the placebo group did not. Additionally 24 patients underwent joint replacement surgery during the trial period despite taking the drug. That is not a huge percentage of the 696 patients but noticeable for a drug that is supposed to treat joint pain.
This drug is not yet approved for clinical use, so the patients in these studies are participating under a clinical trial for this drug. The big question here is IF this drug gets approval for clinical use is the pain relief associated with this drug worth the rapid increase in joint arthritis and increased risk for joint replacement surgery? I think it is obvious that this drug does not treat the cause of the pain and when it comes to osteoarthritis that cause is actually increased joint loading.
Osteoarthritis is the body’s response to an increased load across a joint surface. When there is a increased joint load the body begins to make that joint more stable through a process of slowly fusing the joint together. The soft tissue within the joint gets reabsorbed and more bony tissue builds up. Osteoarthritis takes years to progress which is why we typically see it in people when as they get older but age itself is not an independent variable. Just because you get older doesn’t mean you will have any arthritis in any of your joints. Of course injuries can cause this degenerative process to accelerate. What is really interesting is that studies have shown that arthritis does not correlate well to pain, you can have arthritis in a joint and not have any pain due to it. This is something we have observed in our office as well. So treating the pain associated with an arthritic joint, when that joint is painful, is not treating the cause of the pain. Drugs like Tanezumab just mask the pain while the degenerative process continues.
Now sometimes masking that pain may be helpful like when you are trying to go through therapy or even chiropractic care to treat the cause of the pain. If your pain is too great and you cannot tolerate an adjustment we have sent a patient out for an injection or medications to help us do our job better for you. The problem is when these drugs are used as the only option for your pain. Many of the pain medications out there come with side effects include over the counter medications. You really should not rely on these as your long term approach to manage your joint pain. I would be very concerned about taking Tanezumab if it ever gets through FDA approval. A drug which reduces your pain but puts you at risk for rapidly worsening your joint arthritis and perhaps joint replacement does not sound like a good trade-off. The risk seems greater than the reward in this instance.
Instead what should you be doing about joint pain when it is related to arthritis? It is a word that people don’t like to hear, exercise. When it comes to knee/hip arthritis stretch/strengthen your legs. Look to the bio-mechanics of your feet, a fallen arch is going to affect loading at your knee, hip and even spine. Wear an orthotic improve your foot mechanics. Investigate your posture and the structure of your spine, poor posture is going to load your spinal joints abnormally and contribute to arthritic joints in your spine. This is a key part of what we do in our practice. Examining your posture and structure of your spine compared to normal to determine what effect, if any, it has on a patients symptoms. We also develop a plan to correct poor structure/posture based on the research on posture/spinal structure correction techniques.