Knee osteoarthritis gives roam cartilage

Against osteoarthritis of the knee. For example, the most frequent in front of those of the hip and hand, “Physical activity, weight loss and rehabilitation constitute the tripod of care”, Recall the p^rChristian Roux, of the rheumatology department of the Nice University Hospital Center (Alpes-Maritimes). Nevertheless, As for the therapeutic arsenal, it is essentially based on analgesic treatments.

Among those mentioned by the French Rheumatology Society (SFR) in its 2020 recommendations. Moreover, non-steroidal anti-inflammatory drugs (NSAIDs) per And topical, weak opioids, even the strong in the last intention. Moreover, Regarding paracetamol. In addition, “very modest efficiency, statistically significant but clinically non -relevant”, it can be prescribed as an extra treatment, but not long.

If the intra-articular infiltration of corticosteroids are largely consensus in the event of an inflammatory thrust. Nevertheless, those of hyaluronic acid were released in 2017 following their re-evaluation by the High Authority for knee osteoarthritis gives roam cartilage Health (HAS) which, unlike the SFR, consider them not very effective. Moreover, Two years earlier. Nevertheless, symptomatic antiarthrosics of slow action (AASAL), namely insaponifiable of lawyer and soybeans, chondroitine, glucosamine and diacerein, hitherto reimbursed at 15 %, had suffered the same fate.

Contrasting opinion on slow action antiarthrosics – Knee osteoarthritis gives roam cartilage

Depending on the HAS evaluation. In addition, the effects of aasal on pain and functional discomfort linked to osteoarthritis are minimal. However, On the other hand, taking Aasal is not linked to a lower consumption of NSAIDs. Meanwhile, The SFR explains that their effects on pain. In addition, functional discomfort “can be observed in a statistically significant manner compared to a placebo, but the clinical relevance of this effect at the individual level remains questionable”. For example, Other learned societies no longer recommend them. Therefore, such as the American College of Rheumatology (ACR), which only evokes the use of chondroitine against osteoarthritis of knee osteoarthritis gives roam cartilage the hand.

According to P^rFlorent Eymard. Nevertheless, from the Rheumatology Service of the Henri-Mondor Hospital in Créteil (Val-de-Marne), “The reimbursement has probably decreased the prescription of Aasal. Therefore, Some patients continue to take it because they consider their pain rather soothed. Furthermore, It is a complementary solution, not a miraculous treatment which makes it possible to completely relieve pain ”.

On the patient’s side, the French anti -ulumatic control association (AFLAR) defends these drugs. According to its president, Françoise Alliot-Launois, “AASAL is long -term treatment. Their effects only occur after two, three months. They must be taken at the rate of two to three cures per year, or continuously ”.

A frequent disease … but neglected – Knee osteoarthritis gives roam cartilage

How to explain that, despite its high prevalence, gonarthrosis also has few therapeutic options? The contrast is striking with less frequent rheumatic diseases. such as rheumatoid arthritis and spondylitis, whose management was upset by the arrival of knee osteoarthritis gives roam cartilage biotherapies in the early 2000s.

According to Françoise Alliot-Launois, this low offer would be explained by persistent prejudices “Practitioners like patients. Among the received ideas: it is a normal disease because it is linked to aging. Others say that the joint is worn because we used it too much. Some even think that it is a disease that goes by itself! ».

Another pitfall, the slow evolution of the disease complicates the evaluation of drugs during clinical trials. Furthermore, his pathophysiology remains poorly understood. “When I was a medical student, osteoarthritis was presented to us as a pathology of cartilage”recalls Christian Roux. « Then we realized that the subchondral bone also played an important role. Currently. we realize that inflammation of the synovial fabric is probably one of the first elements of the development of this pathology. »» Hence the difficulty of finding an effective medication: “Most studies relate to mechanisms that relate only knee osteoarthritis gives roam cartilage to a single fabric. There is therefore little observed effect, because osteoarthritis implies various fabrics », Add the Nice rheumatologist.

Considered a « old -fashioned disease » While more than 1 in 2 cases occurs before 55 years old. osteoarthritis is only detected in the painful stage, where drugs could be less effective. According to Florent Eymard, « It can start early in life, and evolves very gradually. When it becomes symptomatic, it is that it is already advanced. In addition, gonarthrosis of an obese diabetic subject is not the same as that of a high -level sportsman. Imagine that one molecule can be effective in these different contexts is perhaps illusory ».

In search of active treatments on the joint

Knee osteoarthritis gives roam cartilage

In 2018. Food and Drug Administration (FDA) granted osteoarthritis the name of « serious condition ». According to this status. a conditional marketing authorization could be issued to a new drug on the basis knee osteoarthritis gives roam cartilage of phase 2 studies, based on intermediate markers (pain, functional discomfort, radiographic progression), then consolidated.

“Research has advanced in recent years. A large number of molecules are being studied, which was not the case there are 15 ans »notes Florent Eymard. “The problem is that few candidates pass the course of studies in animals, or first tests in humans”. Among the most advanced. the Sprifermine, analogous of the FGF18 fibroblast growth factor, and the Lorecivit, Kinases inhibitor of the WNT track, involved in the pathrose pathophysiology, have obtained disappointing results. As for methotrexate, its results diverge from one study to another.

The beneficial effects of certain AGLP-1s

Currently in vogue, the track of the GLP-1 receptor agonists (AGLP-1) arouses interest. During a study published in 2022, semaglutide was associated with significant improvement in pain and physical function in gonarthrosic patients. “Many studies show that weight counts many in the pain of knee osteoarthritis. But knee osteoarthritis gives roam cartilage we don’t know yet if The benefits observed are only due to weight loss. if there is direct action on the joint »explains Florent Eymard.

The relationship between obesity and osteoarthritis seems to exceed the only mechanical constraint linked to joint overload. « There is also a systemic link with weight, observed in digital osteoarthritis [qui implique des articulations non porteuses, NDLR]. Adipose tissue produces substances, including inflammatory cytokines, which can act at a distance on the joint »explains Christian Roux.

The answer to these questions could be decided by the work carried out on another AGLP-1, the Liraglutide. During a French study on the mouse. this molecule, injected with an intra-articular level, led to a reduction in pain, as well as a decrease in joint inflammation and the production of enzymes involved in the destruction of cartilage. Coordinated by the rheumatology team at Saint-Antoine Hospital (Paris), a first try is about to start knee osteoarthritis gives roam cartilage with man.

Other molecules to the test

Other tracks, joint plasma injection rich in platelets (PRP) could relieve pain and reduce joint stiffness. “The results are heterogeneous. but the meta-analyzes suggest effectiveness perhaps greater than hyaluronic acid and more durable than corticosteroids”notes Florent Eymard. As for the injections of stem cells, which aim to regenerate cartilage, recent results have proven to be disappointing. Also under study, arterioembolization consists in clogging the geniculated arteries which feed the joint. This technique delivered encouraging results during open studies. Two projects are expected to start in France soon. one in gonarthrosis, the other (coordinated by Christian Roux) in patients with persistent pain after laying a knee prosthesis.

Retain

• Very common rheumatism, knee osteoarthritis has a low therapeutic arsenal.
• Among the pitfalls of clinical research. an erroneous perception of the disease, a complex and variable pathophysiology from one subject to another, diagnoses made at an knee osteoarthritis gives roam cartilage advanced stage.
• Despite failures, research continues on various fronts. Among the most promising tracks, that of the GLP-1 receiver agonists.