New osteoarthritis study shows most treatments do not work

Meta-analysis calls into question the premises underlying classic osteoarthritis treatment guidelines.

Despite the billions of Euros spent on osteoarthritis treatments in Germany, the effectiveness of those treatments remains highly controversial among experts. According to the findings of a large-scale study presented today by Carsten Moser and Peter Wehling of Düsseldorf at the Orthopaedics and Trauma Surgery Congress in Berlin, the largest German orthopaedics conference, some therapies have now been shown to be ineffective while others are downright risky.

Initially, Moser and Wehling set out to evaluate the scientific evidence of effectiveness of various treatments for knee osteoarthritis (OA). "The results of our systematic analysis of the international scientific literature on this subject were sobering, to say the least. After analysing all of the published guidelines and hundreds of studies, we found that the very frequently prescribed anti-rheumatic drugs actually have a very low efficacy with surprisingly serious side effects", said Dr. Peter Wehling of the Molecular Medicine Foundation, speaking in Berlin today. Anti-rheumatics are analgesics such as acetaminophen that are used for light pain. "The analysis of all the studies makes it clear that there is no single standard treatment for osteoarthritis. Rather, what is needed is an individual treatment plan based on a thorough diagnosis of each patient's symptoms", adds co author Carsten Moser of the Grönemeyer Institute for Microtherapy in Bochum. The results are all the more surprising, according to the authors, because they call into question the very premises on which the classic treatment methods and international guidelines for osteoarthritis are founded.

The study

Moser and Wehling's meta-analysis of the international literature on osteoarthritis treatment consisted of a systematic review and analysis of 21 national and international guidelines, 60 literature reviews and 300 current randomized clinical trials. The analysis revealed that weight loss, muscle strengthening and the use of injections (e.g. steroid or orthokine injections) injection were among the more effective treatments. Others, such as prescription medications and arthroscopy, were surprisingly ineffective from the point of view of a purely evidence-based analysis. Drug-based therapies in particular result in little or no improvement in joint function. Moreover, this treatment method is notable for the high number of side effects, including stomach ulcers and increased risk of heart attack.

Facts and figures

In Germany, osteoarthritis affects roughly 11 million people, of whom five million suffer from knee osteoarthritis. Most of these patients are treated with non-steroidal anti-rheumatics (NSARs). Researchers have discovered that only 15% of OA patients prescribed NSARs were still taking these medications after one year. In Great Britain alone, gastrointestinal bleeding, one of the clinically relevant side-effects of NSARs, is responsible for some 2,200 deaths and approximately 12,000 emergency admissions to hospital every year. This side effect is especially significant for elderly patients, the majority of whom suffer from some kind of osteoarthritis.

(Source: Stiftung Molekulare Medizin: October 2008)