Cartilage Gives Early Warning of Arthritis, Study Finds

Damage to the tissue that cushions joints occurs even before people feel pain, research shows

By Robert Preidt

HealthDay Reporter

TUESDAY, April 2 (HealthDay News) -- Exercise-related damage in cartilage can help identify people with the earliest stages of osteoarthritis, a new study reveals.

The findings could improve early detection of the painful joint disease and could also be used to improve methods of repairing damaged cartilage, said study senior author Alan Grodzinsky, of the Massachusetts Institute of Technology, and colleagues.

For the study, the researchers developed a method that identifies osteoarthritis-related changes that occur in cartilage in response to high-load activities such as running and jumping.

Cartilage is firm, rubbery tissue that cushions bones and keeps them from rubbing together. When osteoarthritis begins to develop, the ability of cartilage to resist physical-activity-related impact is reduced. This is now known to be due to the loss of molecules called glycosaminoglycans (GAGs).

Using their new system, the researchers found that GAG-depleted cartilage loses its ability to stiffen under the forces of high-load activities. GAG loss also caused an increase in the depletion of fluids from the cartilage, which likely reduces protection against the impact of high-load activities.

The findings show how GAG loss at the earliest disease stages reduces the ability of this tissue to withstand high-load activities, according to the study, which was published in the April 2 issue of the Biophysical Journal.

"This finding suggests that people with early degradation of cartilage, even before such changes would be felt as pain, should be careful of dynamic activities such as running or jumping," Grodzinsky said in a journal news release.

Osteoarthritis affects about one-third of older adults and is the most common type of joint disorder.

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Therapy as Good as Surgery for Some With Torn Knee Cartilage

Study looked at osteoarthritis patients in severe pain

By Robert Preidt

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Physical therapy is comparable to surgery in improving movement and reducing pain for some patients with knee arthritis and torn knee cartilage, new research finds.

Many middle-aged and older adults have severe knee pain due to a tear in the meniscus, a crucial support structure in the knee that is often damaged in people with knee osteoarthritis.

Each year in the United States, more than 450,000 arthroscopic surgeries are performed to treat meniscal tears, but scant data exist to help doctors determine if physical therapy or surgery is the best treatment for a patient, according to the researchers at Brigham and Women's Hospital in Boston.

Their study of 351 patients -- all over age 45 with knee pain, meniscal tear and knee osteoarthritis -- suggests that physical therapy may be equal to surgery for some patients.

Participants were randomly assigned to be treated with either arthroscopic surgery or physical therapy. When they were assessed six and 12 months later, both groups had substantial and similar improvements in movement.

The study was scheduled for presentation this week at the annual meeting of the American Academy of Orthopaedic Surgeons, in Chicago, and published online March 19 in the New England Journal of Medicine.

"Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows that there is no single 'best' treatment," principal investigator Dr. Jeffrey Katz said in a hospital news release.

However, the release noted that some of the original physical therapy patients did eventually opt for surgery.

"Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone. In this study, one-third of patients who received physical therapy ultimately chose to have surgery, often because they did not improve with [physical therapy]," added Katz, who is director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital, and a professor of medicine and orthopedic surgery at Harvard Medical School.

One expert agreed with those conclusions.

"The article reinforces the standard that if a patient suffers a degenerative meniscal tear related to mild to moderate osteoarthritis then the first line of treatment is typically physical therapy," said Dr. Leon Popovitz, an orthopedic surgeon at Lenox Hill Hospital in New York City.

"If patients do not improve, then arthroscopy is a viable option to improve their symptoms," he added.

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Therapy as Good as Surgery for Some With Torn Knee Cartilage

Title: Therapy as Good as Surgery for Some With Torn Knee Cartilage
Category: Health News
Created: 3/19/2013 10:35:00 AM
Last Editorial Review: 3/19/2013 12:00:00 AM

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