A discovery led by researchers from the Leeds NIHR Biomedical Research Centre (BRC), and funded by charity Versus Arthritis, could offer hope for millions of people across the UK suffering with chronic pain and stiffness caused by osteoarthritis of the knee.
The results of the clinical trial show methotrexate, a medication already used for autoimmune conditions, to be effective in relieving both the pain and stiffness caused by knee osteoarthritis which affects 5.4 million people in the UK, and 364 million globally. Osteoarthritis occurs when the body can no longer maintain the joint to keep it healthy and pain free.
Current pain relief options for knee osteoarthritis are limited, short term and often have minimal benefit. According to surveys carried out by Versus Arthritis, a third of people with osteoarthritis said they experienced severe pain every day. If these survey results are representative of the UK population, it means millions of people are living with debilitating pain because of their osteoarthritis every single day of their lives.
The research published in medical journal Annals of Internal Medicine, was led by Professor Philip Conaghan (Right) and Dr Sarah Kingsbury (Left) of the Leeds NIHR BRC.
Professor Conaghan explained the significance of the trial: “There is an urgent need for treatments to help relieve the pain of osteoarthritis. Although there have been many trials of potential new treatments, these have largely failed to demonstrate any benefit, and so people with osteoarthritis have very few options. We are therefore very excited by our findings which show that methotrexate may offer a potential new treatment.
“Our study demonstrates that a drug already commonly used for rheumatoid arthritis, methotrexate, might help the pain of osteoarthritis, and also gives us a clue about which subset of patients, those with elevated blood inflammation levels, might get benefit from this therapy.”
Working with 15 hospitals across the UK, the team recruited 155 patients with knee osteoarthritis who were not responding to current medications. Patients were split into two groups with half given a placebo and half given methotrexate in tablet form once weekly over a period of 12 months. The results showed those taking methotrexate, which reduces the activity of the immune system, experienced less pain and stiffness at six months.
Dr Kingsbury added that further research would now be required: “Whilst this study offers real promise of a new treatment for osteoarthritis, there are still questions to be answered before methotrexate can be considered for widespread introduction.
“Our findings suggest that some people may have greater benefit than others from methotrexate, and so our next step is to understand this better, as well as confirming the best dose of methotrexate to use and to consider the cost-effectiveness of methotrexate as a treatment for osteoarthritis.”
Military veteran Roger Van-Cauter aged 73 from Shropshire explains what it is like to live with arthritis.
He said: “Osteoarthritis is my main issue – it’s very painful and because I was super fit all my joints are deteriorating. I’ve had trouble with my knees for a while really. I was diagnosed with osteoarthritis in my 40s after experiencing pain completing the Great North Run.
“I used to do a lot of triathlons, mountain climbing and marathons. Now I’m a bit wonky on my legs even just walking. When you’re at home on your own, if you can’t do things to take your mind off the aches and pains, it’s really hard and affects your mental health.”
Exercise, weight management and physiotherapy are the recommended approaches for management of osteoarthritis however the significant levels of pain and stiffness experienced by patients usually necessitates additional therapies such as medication, which are limited. Joint replacements can be considered for long term relief for those with very advanced osteoarthritis, but NHS waiting lists are often long and people face many years in pain.
Professor Lucy Donaldson, Director of Research at Versus Arthritis, who funded the research, hailed the trial results as a promising breakthrough.
“Osteoarthritis research has come far in our lifetime,” she said, “but we still have a long way to go. New ways to treat osteoarthritis pain are urgently needed, so the results from this study are very exciting. These findings could offer real hope for millions affected by knee osteoarthritis.
“Against a backdrop of unacceptably long waiting lists for joint replacements, this study underlines the value of research and why arthritis needs greater prioritisation and investment.”