How to Reverse the Progression of Osteoarthritis

. It involves the wearing down of cartilage at the ends of bones. In osteoarthritis, the degeneration of joints progresses over time. For many patients, it progresses to the point of needing surgery. There is no cure, so the goal of treatment is to improve pain and function for as long as possible.

When osteoarthritis starts slowing a person down, healthcare guidelines generally recommend treatments that fit the following criteria:

• Conservative
• Exercise-based
• Non-surgical
• Non-pharmacological

Nevertheless, a high percentage of patients reporting osteoarthritis pain are not offered exercise therapy.(3) This is unfortunate considering that exercise therapy is known to reverse the progression of osteoarthritis.

For instance, J. H. Abbott (Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand) recently published an interesting study measuring the cost-effectiveness of adding different types of physiotherapy to real-world usual care.(4) Usual care involved seeing the primary care provider and receiving whatever advice and/or medications were recommended. Researchers divided patients into groups receiving no physiotherapy, manual therapy, exercise therapy supervised by a physiotherapist, or a combination of the two. Abbott and colleagues measured healthcare spending for two years.

After two years, exercise therapy (when added to usual care) cost less than usual care alone. Supervised exercise therapy saved more in healthcare spending than the other three groups. The main reason for this was that patients in the exercise therapy group continued to get better even after their initial seven physiotherapy visits were over. Patients in the usual care group and the other groups tended to show the usual progression of arthritis. This was probably because patients with ample exercise therapy visits learn to continue their therapeutic exercises independently. It appears that supervised exercise therapy is a way for patients to take charge of their osteoarthritis and manage its progression themselves. 

References:

1. The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.
2. Larmer PJ, Reay ND, Aubert ER, Kersten P. Systematic review of guidelines for the physical management of osteoarthritis. Archives of Physical Medicine and Rehabilitation. 2014 Feb 1; 95(2): 375-89.
3. Egerton T, Diamond LE, Buchbinder R, Bennell KL, Slade SC. A systematic review and evidence synthesis of qualitative studies to identify primary care clinicians' barriers and enablers to the management of osteoarthritis. Osteoarthritis and Cartilage. 2017 May 1; 25 (5): 625-38.
4. Barker KL, Newman M, Stallard N, Leal J, Lowe CM, Javaid MK, Noufaily A, Adhikari A, Hughes T, Smith DJ, Gandhi V. Exercise or manual physiotherapy compared with a single session of physiotherapy for osteoporotic vertebral fracture: three-arm PROVE RCT. Health Technology Assessment (Winchester, England). 2019 Aug; 23 (44): 1.