by Carole Jackson, Bottom Line Health
Letâs say you fall and injure your knee, hip or shoulder. Once you recover, youâre likely to forget about the injured joint — that is, until you develop osteoarthritis there… maybe years later! In fact, of the 27 million Americans with osteoarthritis (the most common form of arthritis), three million of those cases were caused by the breakdown of cartilage from joint injuries. The condition is known as injury-induced or post-traumatic osteoarthritis. Once it sets in, thereâs not much that conventional doctors can do but ease symptoms with painkillers or, in severe cases, suggest joint-replacement surgery. But researchers now say they may have a way to stop this type of arthritis before it ever gets started!
Attacking Yourself
When there is cartilage breakdown after a joint injury, a corticosteroid is often used to help reduce the pain. According to a new MIT study published in Arthritis Research & Therapy, doctors have found that using a similar type of steroid on an injured joint right away — even before cartilage breakdown is present — may help prevent the breakdown from happening in the first place. “The findings are very promising,” I was told by the studyâs lead researcher, Alan Grodzinsky, ScD, a professor of biological, mechanical and electrical engineering and the director of MITâs Center for Biomedical Engineering. To understand why, consider what happens after a joint injury. As you surely know from personal experience, inflammation sets in — thatâs what causes much of the initial stiffness, swelling and pain after you hurt a joint.
Inflammation is actually a healing tool. When a joint is injured, cells within the affected tissues secrete proteins called cytokines, which modulate the bodyâs response to disease and inflammation. But, Dr. Grodzinsky explained, thereâs an unfortunate consequence of this normal inflammatory response. “Cytokines cause cells in the joint to make enzymes that destroy the proteins in cartilage” — and that, of course, is the beginning of cartilage breakdown. The breakdown can take years, sometimes a decade or more, and meanwhile, you may have no idea that this is happening. So if you can keep inflammation down initially, then in theory cartilage breakdown can be avoided.
In this study, researchers explored whether dexamethasone, a steroid used for decades to relieve pain in established osteoarthritis and late-stage rheumatoid arthritis patients, could be used to prevent injury-induced arthritis. They set up a lab experiment using bovine and human knee cartilage kept alive in a lab culture. They damaged the tissue, essentially creating an injury, and then put the tissue in a fluid containing inflammatory cytokines identical to the ones that the body creates. When the damaged tissue was treated immediately with the dexamethasone, cartilage breakdown stopped. The drug also halted the breakdown of cartilage in specimens treated a day or two later — an important finding, said Dr. Grodzinsky, since patients with an injury might not realize that their injury is severe enough to require medical attention right away.
For Young… and For Old
Perhaps after more research, doctors will start to treat joint injuries immediately with a steroid — even in people who are young — as a way to prevent arthritis from developing in years to come. Dr. Grodzinsky pointed out that there is still a lot to learn. So researchers are planning animal studies to determine the most effective dose and the best method of drug delivery to restrict the steroid to the injured joint tissue and minimize side effects. Although itâs not yet certain how many treatments may be needed, if they prevent a lifetime of pain, it sounds well worth the effort.
 Source(s):
Alan Grodzinsky, ScD, a professor of biological, mechanical and electrical engineering and the director, Center for Biomedical Engineering, MIT, Cambridge, Massachusetts.