Tag Archive | synovitis

Methotrexate for Knee OA?

Maybe—but only if larger, longer-term studies replicate the findings from a randomized trial of 144 patients (mean age = 66 years) published recently in the Annals of the Rheumatic Diseases.

Subjects with knee osteoarthritis (OA) in the double-blind Annals study received either placebo or up to 25 mg per week of oral methotrexate over a 28-week period. At 28 weeks, researchers found greater reductions in knee pain and larger improvements in scores of physical function and activities of daily living in the methotrexate group than in the placebo group. The authors also noted a significantly greater reduction in synovitis, measured both clinically and with ultrasound, in the methotrexate group relative to the placebo group.

Methotrexate is a powerful drug prescribed to treat certain cancers and refractory rheumatoid arthritis, but it has many well-known and potentially serious side effects, such as hematopoietic suppression and liver toxicity. Nevertheless, these authors reported few adverse events; those that did occur included self-limiting mucositis, alopecia, GI disturbance, and transaminitis.

While some people are thought to have a more inflammatory phenotype of osteoarthritis than others, this study did not stratify patients along inflammatory lines, so further research will be needed to determine whether methotrexate’s clinical benefits accrue equally to OA patients generally, or mostly to those with the inflammatory subtype.

Two New “Solutions” to Prickly Orthopaedic Problems

A study on rat knees in Osteoarthritis and Cartilage suggests that irrigating joints with hyperosmotic saline (600 mOsm) reduced surgically induced chondrocyte death, relative to irrigation with normal saline. Other measures of tissue repair and inflammation were also better in the joints that were irrigated with the hyperosmotic solution, although mild synovitis occurred in all joints regardless of the solution used. In a news release, study co-author Andrew Hall said, “Our study could have major implications for tens of thousands of people…It’s a cheap, simple solution that can protect the cartilage in the joint during arthroscopy and surgery.”

In a study on dog knees in Clinical Orthopaedics and Related Research, osteochondral allografts preserved in a special solution at room temperature yielded greater chondrocyte viability at 60 days than allografts stored within a medical-grade refrigeration unit. Viable grafts from each type of preservation delivered equivalent radiographic and biomechanical outcomes after six months. Commenting on this more than doubling of graft-storage life, study co-author James Stannard, MD, said, “The benefit to patients is that more graft material will be available, and it will be of better quality. This will allow us as surgeons to provide a more natural joint repair option for our patients.”

Readers should remember that these proof-of-concept studies were performed in animal models. Whether these simple “solutions” will work with human bone and cartilage tissue remains to be seen.