OA Pain Relief
In OA, “modifying disease is not enough. Our patients complain of pain. They don’t complain of their X-rays,” said David Walsh, MD, director, Arthritis Research UK Pain Centre at the University of Nottingham. “There is a clinical conundrum with pain relief in arthritis. Do we want to treat the pain? Will we cause problems if we just mask pain?” Normal activity, or even running, does not worsen OA or pain.10
Potential therapeutic targets in OA include structural abnormalities: bone marrow lesions (BMLs), synovitis and cartilage damage, said Dr. Walsh. Zoledronic acid reduced knee pain and BMLs in OA patients in six months in one study, but at two years, patients showed no significant improvement.11
“It’s not to say that BMLs aren’t a realistic target for treating pain, but the link may not be structural,” he said. Subchondral bone may reveal clues. “There is increased bone turnover, increased osteoclast activity and a reduction in PH, which we know sensitizes peripheral nerves.”
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