Is Osteoarthritis Reversible?

Is osteoarthritis reversible?

Check out this answer from Consensus:

While osteoarthritis has long been considered an irreversible condition, emerging evidence suggests that its progression can be halted or even reversed under certain conditions. Advances in pharmacotherapy, minimally invasive interventions, and a deeper understanding of the disease’s cellular and molecular mechanisms offer hope for more effective management of OA. Further research, particularly large-scale randomized controlled trials, is needed to validate these promising approaches and translate them into clinical practice.

Osteoarthritis (OA) is a degenerative joint disorder that predominantly affects the elderly population. Traditionally, OA has been viewed as an irreversible condition characterized by the progressive deterioration of joint cartilage. However, recent advances in medical research suggest that the progression of OA might be halted or even reversed under certain conditions. This article explores the current understanding of OA reversibility, examining both experimental and clinical evidence.

Understanding Osteoarthritis

Osteoarthritis is often considered a wear-and-tear disease, where the cartilage that cushions the ends of bones in the joints gradually deteriorates. This leads to pain, swelling, and reduced joint mobility. The disease is typically progressive, meaning it worsens over time, and has been regarded as irreversible once it becomes symptomatic1.

Evidence of Reversibility

Clinical Observations

There have been documented cases where severe OA showed signs of partial reversal. For instance, an 85-year-old man exhibited a reappearance of hip joint spaces, as assessed radiologically, which persisted until his death at age 921. Such cases provide anecdotal evidence that OA may not be as inexorably progressive as once thought.

Pharmacotherapy Advances

Emerging pharmacologic therapies are showing promise in modifying the progression of OA. Traditional OA drugs like NSAIDs and corticosteroids primarily focus on pain relief and do not reverse joint damage. However, newer disease-modifying drugs target the underlying pathophysiology of OA, including cartilage anabolism/catabolism, subchondral bone remodeling, and synovial inflammation. Agents such as bone morphogenetic protein-7 (BMP-7), fibroblast growth factor-18 (FGF-18), and interleukin-1 (IL-1) inhibitors have shown potential in modifying OA progression with minimal adverse effects2.

Minimally Invasive Interventions

Research has identified the role of joint-resident mesenchymal stem cells (MSCs) in maintaining local homeostasis and regulating tissue repair. These MSCs create a regenerative microenvironment that could potentially halt and reverse early-stage OA. Interventions employing platelet-rich plasma (PRP), MSCs, and exosomes are being investigated for their ability to reverse the course of OA3.

Mechanisms of Reversibility

Cellular and Molecular Insights

The understanding of OA pathophysiology has advanced significantly. The disease involves a complex interplay of inflammatory and immunologic processes, including the activity of synoviocytes, chondrocytes, and local immune-inflammatory mediators. By targeting these processes, it may be possible to disrupt the vicious cycle of joint degradation and promote tissue regeneration3.

Practical Clinical Management

Based on the cell biology of hyaline cartilage, synovium, and subchondral bone, practical clinical management strategies are evolving. Aspirin, for example, has been emphasized as a drug of choice due to its anti-inflammatory properties and potential to support joint health1.

 

 

Is osteoarthritis reversible?

L S Simon has answered Uncertain

An expert from Independent in Rheumatology

We yet do not know the controlling influences regarding structural progression in OA. The role of inflammation, genetics, and mechanics remain difficult to tease out. Structural modification is being pursued but if you improve cartilage, is that enough, or does the entire joint need to be addressed and in whom.

 

Is osteoarthritis reversible?

Sang Hee Lee has answered Likely

An expert from Myongji University in Stem Cells

I think that osteoarthritis (OA) is likely reversible using ADSCs/PRP (Adipose tissue-derived stem cells/platelet-rich plasma) therapy in the form of stromal vascular fraction (SVF).

According to our previous report, our retrospective cohort study demonstrated no evidence of neoplastic com­plications in any implant sites in 91 patients with 100 joints, some of whom were moni­tored with high field MRI tracking and via general surveillance. Based on this longitudinal cohort, the autologous and uncultured ADSCs/PRP therapy in the form of SVF is considered to be safe and shows cartilage regenerations, when used as percutaneous local injections for patients with degeneration of only cartilage and bone.

 

Is osteoarthritis reversible?

Lori Thein Brody has answered Likely

An expert from Rocky Mountain University of Health Professions in Medicine

No and yes is the short answer. The pathology of osteoarthritis is not reversible, but the symptoms are. There is little correlation between radiographic findings of osteoarthritis and its related symptoms. Symptoms (pain, swelling) often arise when the joint is overloaded (generally due to activity) and inflammation develops. It is this inflammatory process and swelling that produces pain. Seeing a physical therapist for one or two visits can help you learn how to manage your symptoms. For example, at the knee, there is evidence that strengthening the muscles in the lower extremity can decrease the loading across the knee joint. This may slow progression of the osteoarthritis, but cannot reverse the pathology.

 

Is osteoarthritis reversible?

Henning Bliddal has answered Unlikely

An expert from University of Copenhagen in Rheumatology

OA is defined by structural lesions, which are permanent, i.e. not reversible, and clinical symptoms, which may be modified.

 

Is osteoarthritis reversible?

I A C Baert has answered Likely

An expert from University of Antwerp in Physiotherapy

For me, osteoarthritis (OA) is a whole organ disease, she whole joint is affected. Although focal cartilage damage is an important characteristic of knee OA joint pathology, there has been a gradual shift from a cartilage-centered towards a whole joint approach, including events in the subchondral bone, ligaments, menisci and synovial and adipose tissues. Although regeneration of catilage is very limited, other tissues do have regeneration capacities. For that reason, for me, OA is kind of reversible.

Conservative treatment has showns to have significant effect on pain and functionality, so also the symptoms of OA are reversible.

 

Is osteoarthritis reversible?

F Dobson has answered Uncertain

An expert from University of Melbourne in Physiotherapy

Until more is known about the actual cause(s) then this is still unknown. We do know exercise reduces symptoms, improves function and health-related quality of life.

 

Is osteoarthritis reversible?

Nicola Maffulli has answered Unlikely

An expert from Queen Mary University of London in Medicine

Despite what colleagues who have vested interests, patients can experience amelioration of symptoms, but the articular cartilage really shows little evidence of regeneration. Up to now, all the well performed independent studies with no bias by researchers and patients have confirmed that once it is gone, it is gone. Hyppocrates was right, and we need to perform more and better studies. Whomever is involved in this field is unlikely to be jobless any time soon!

 

Is osteoarthritis reversible?

Rik  Lories has answered Uncertain

An expert from Katholieke Universiteit Leuven in Rheumatology

This question is more complex than one would anticipate and there is no yes/no answer. Osteoarthritis is a disease characterised by progressive damage to the joints. All tissues of the joint can be affected: the cartilage that caps the bones, the cartilage-underlying bone and the soft tissues of the joint. Progressive damage to the joints leads to the characteristic symptoms of osteoarthritis: pain and loss of function.

Cartilage has a very limited repair capacity. Traumatic cartilage lesions may only heal in young patients. Therefore damage to the cartilage is considered irreversible and can increase over time at different paces. However, symptoms may take time to develop.

There are currently no available therapies to heal the cartilage although new treatments are under development. Thus, the disease processes may be irreversible. However, symptoms such as pain and loss of function may be reversible with the use of pain killers and good rehab exercises to strengthen the muscles around the joint. Therefore, osteoarthritis from a clinical perspective may be reversible for some patients.

 

Is osteoarthritis reversible?

Kristin Valdes has answered Extremely Unlikely

An expert from Gannon University in Medicine, Occupational Therapy

Osteoarthritis is a degenerative condition that involves deterioration of the cartilage (cushioning) that covers the end of the bones. When the cartilage deteriorates the bone surfaces can rub together causing pain and inflammation. Medication can be used to decrease the inflammation & control pain and exercises can be used to maintain the stability of the joint, but unfortunately at this time, cartilage can not be regenerated.

 

Is osteoarthritis reversible?

Kathryn Mills has answered Likely

An expert from Macquarie University in Physiotherapy, Musculoskeletal Science

Osteoarthritis is a complex disease of the whole joint, but is thought of as both an illness and a disease. The disease is the structural damage to the joint. This is not reversible and usually progresses over time. Osteoarthritis-the-illness is the collection of signs and symptoms that are typically associated with osteoarthritis. The most frequent symptom is pain and a frequent sign is morning stiffness that lasts for about 30 minutes.

The illness of osteoarthritis (pain, joint swelling, joint stiffness, depression, social isolation, limited mobility etc) is reversible. This is why it is so important that people seek non-surgical forms of management prior to signing up to have their joint replaced. A combination of weight-loss, land-based exercise and education has been found to very effective at reducing the signs and symptoms associated with osteoarthritis. It is possible to be pain-free even with x-rays or MRIs (another form of medical imaging) that look terrible. A common phrase to describe this is “bone on bone”. However, numerous studies have demonstrated that there is no association between what a joint looks like when imaged and how a person feels or how active they can be.

Important take-home messages when discussing osteoarthritis are

(1) if you have been told by you family doctor or GP that you have osteoarthritis, one of the most important things you can do is to stay physically active. This keeps the muscles that support your joint strong and helps manage your body weight. Both of these are very important to reduce your pain and keep you doing all of the activities that you like to do.

(2) You do not need an x-ray or image to “confirm” your diagnosis. Imaging will not change your management, so it is unnecessary cost and exposure to radiation

(3) Osteoarthritis is a very common as people get older. Think of it more like a joint wrinkle as opposed to a disability sentence

(4) It is likely that from time to time, you may experience a “pain flare”. These are transient increases in your pain that may last for a few days or weeks. They are not a sign that you are getting worse, but are normally a reaction to “over-doing” things in some way. You can work with your doctor or physiotherapist to help identify your risk factors for a pain flare and how to manage them.

 

Is osteoarthritis reversible?

Hanatsu Nagano has answered Likely

An expert from Victoria University in Biomechanics

Pain associated with osteoarthritis is thought to be due to micro-fractures caused by direct bone-to-bone collision, which becomes problematic when articular cartilages are diminished.

To prevent thinning of articular cartilage, pressure relief is important.

For example, reduction of knee adduction moment could prevent articular cartilage to be thinned at the medial compartment of the knee.

Once articular cartilage is reduced, re-synthesis is the essential process but this capacity may be reduced or lost depending on a number of factors.

Hence, yes, there are many possibilities to prevent OA and increase thickness of articular cartilage to improve the condition.

However, in some cases where re-synthesis of articular cartilage is not possible, OA may not be reversible, without future technology that can artificially thicken articular cartilage or effectively stimulate re-synthesis processes.

 

Is osteoarthritis reversible?

Hemant Pandit has answered Unlikely

An expert from University of Leeds in Musculoskeletal Science

Osteoarthritis (OA) is usually considered as a wear and tear of a joint – typically the articular cartilage. Knees, hips and spine are commonly affected although shoulder, base of thumb and ankle are also not that uncommon.

Traditionally end-stage OA is considered to be irreversible. This is for the radiographic appearance rather than symptoms. Patient symptoms can vary from day to day and in some cases (e.g. knee OA) there can be huge discordance between x-ray appearance and patient symptoms.

Some techniques can reduce the rate of progression or indeed in early stages may even reverse the OA process – in general the evidence is limited and although these techniques aimed at cartilage regeneration have been extensively studied in the long-run the OA tends to get worse with time.

 

Is osteoarthritis reversible?

Peter Millett MD has answered Uncertain

An expert from The Steadman Clinic in Orthopedics, Musculoskeletal Science

The simple and short answer to this question is “not yet, but hopefully soon.” OA is increasingly prevalent in our society. Moreover there are two strong factors at work: (1) the overwhelming demographic trends of our population getting older, which increases the prevalence of OA and (2) the societal trend for people to be and to remain more active, even into older age, which increases the emphasis on maintaining mobility and staving off the effects of OA.

OA in older patients can be treated effectively with total joint replacement surgery. OA in young and active patients however remains a challenging problem. Fortunately there are new treatments and procedures, which can be used to eliminate pain, restore function, and delay the need for total joint replacement. For example, arthroscopic procedures can now be used to treat OA of the shoulder, hip, knee, and ankle. These procedures can be augmented by biologic treatments such as cartilage grafts, platelet rich plasma, and bone marrow aspirate concentrate to enhance and restore joints, which have become arthritic.

While presently there is no true cure for OA, a myriad of treatment options exists. The future remains quite exciting as there will no doubt be new regenerative therapies which will reverse OA, keeping people active and preventing, or at least delaying, the need for prosthetic total joint replacement. While OA is presently quite treatable, more work needs to be done to figure out how to make OA reversible.

 

Is osteoarthritis reversible?

David B Burr has answered Extremely Unlikely

An expert from Indiana University School of Medicine in Musculoskeletal Science

No. There is no convincing evidence that OA is reversible once there is cartilage loss. It may be possible to slow progression by using bone anti-remodeling agents if the degeneration is not too far advanced, but no one has shown that cartilage that is lost can be re-gained.

 

Is osteoarthritis reversible?

 

Is osteoarthritis reversible?

Sebastián Irarrázaval has answered Unlikely

An expert from Pontificia Universidad Católica de Chile in Medicine

Latest paper relating to this where I am co-author here.