A discovery by researchers at the University of Leeds and Leeds Teaching Hospitals NHS Trust offers new hope to people with osteoarthritis of the knee.
Leeds clinical trial
The study, funded by the charity Versus Arthritis and published in the medical journal Annals of Internal Medicine in July 2024, is good news for the 5.4 million people in the UK who are affected by the condition, which causes chronic pain and stiffness. Osteoarthritis is a loss of cartilage in the joints, leading to inflammation, pain and loss of function. It can affect any joint in the body and is a degenerative condition which means it worsens over time.
At present, the pain relief options for people with knee osteoarthritis are limited and not always effective. A third of people with osteoarthritis say they experience “severe pain” on a daily basis, according to surveys carried out by Versus Arthritis. With estimates of 364 million people with knee osteoarthritis around the world, this suggests a high level of suffering and debilitating pain caused by the condition.
A promising result
The Leeds clinical trial found that methotrexate, a medication used for autoimmune conditions, is also effective at relieving the pain and stiffness of knee osteoarthritis. This broadens the potential treatment options for people with the condition, although further research is needed to understand why some patients appear to experience greater benefit from the drug than others. There is also work to be done to consider the cost-effectiveness of methotrexate as a widespread treatment for osteoarthritis and to determine the optimum dose. It is also important to consider overall ‘risk versus benefit’, as with any drug, including methotrexate, there is always a side effect profile.
Methodology
The research was led by Professor Philip Conaghan and Dr Sarah Kingsbury from the Leeds NIHR Biomedical Research Centre, hosted by Leeds Teaching Hospitals NHS Trust in partnership with the University of Leeds. The researchers worked with 15 hospitals across the UK, recruiting 155 patients with knee osteoarthritis. The patients studied were not responding to their current medication. The group was divided into two. Half of the patients in the study were given a placebo and half were given methotrexate in tablet form once a week for 12 months.
Findings
The results showed that methotrexate, which works by reducing the activity of the immune system, reported less pain and stiffness at six months.
Treating knee osteoarthritis at Carrothers Orthopaedics
Carrothers Orthopaedics welcome the research as a promising step forward in the treatment of osteoarthritis, although there is clearly more work to be done before the drug can be routinely prescribed to patients. In the meantime, there are treatment options that can help to relieve the symptoms of knee osteoarthritis and these vary according to the severity of the condition.
In the early stages, losing even a small amount of weight can reduce the pain of knee osteoarthritis. This is because your knees absorb a force equal to between three and six times your weight each time you take a step. We take thousands of steps each day, placing the knee joints under significant stress and contributing to pain, stiffness and swelling. Carrying extra weight can also speed up the loss of cartilage in the knees, which leads to the bones starting to rub against each other, causing further pain. Each pound of weight you lose relieves four pounds of pressure on your knees so losing weight is a positive way to manage the symptoms of knee osteoarthritis.
Gentle exercise helps to strengthen the muscles around the knee joint which can reduce pain, while stretching helps to keep the joint flexible. A physiotherapist will recommend exercises to improve your mobility and relieve symptoms. Alongside painkillers and anti-inflammatory medication, injections of corticosteroids into the knee joint can help to reduce inflammation, while hyaluronic acid injections may improve lubrication of the joint.
Arthrosamid injections are also proving highly effective in many cases to diminish pain, decrease joint stiffness and improve the knee’s mobility.
Wearing a knee brace can help to disperse the weight away from the damaged part of the knee joint or support the joint overall. It is also important to take vitamin D.
For more severe knee osteoarthritis, surgery is normally the most effective solution. Arthroscopy is a keyhole procedure which is used to remove damaged cartilage and repair damaged tissue. It is often used on younger patients to delay the need for more serious surgery. Osteotomy may be used to realign the knee if the damage is confined to one part of the joint or if your knee fails to heal properly after a fracture. Ultimately, a knee replacement offers the most effective long-term relief for severe knee osteoarthritis. This entails removing the damaged sections of the knee joint and replacing them with an artificial implant. A prosthetic knee generally lasts anywhere between 15 and 25 years.
Mako robotic assisted total or partial knee replacement can yield additional benefits in reduced recovery time, comfort of the implant and less scarring, due to the robotic arm assisting the expertise of the surgeon in the implant placement. More information can be found on our blog and in the below Guide.
For more information about diagnosing and treating all forms of arthritis, contact us.
Related reading
There are many resources on our website about knee osteoarthritis. Here are some useful articles to get you started:
Treatment for Knee Arthritis: 2024 Update
Having a Partial Knee Replacement? What You Need to Know About Mako Robotic Assisted Surgery
Mako Robotic Assisted Surgery – A Patient Guide for Total Knee Replacement
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