Recommendation ID
CG177/5
Question
Treatments that modify joint structure in people with osteoarthritis:- In people with osteoarthritis, are there treatments that can modify joint structure, resulting in delayed structural progression and improved outcomes?
Any explanatory notes
(if applicable)
Why this is important:- There is evidence from observational studies that factors affecting structural joint components, biomechanics and inflammation in and around the joint influence the progression of osteoarthritis. Symptoms appear to be more closely linked to structure than was once thought, so preventing progression of the structural deterioration of a joint is expected to deliver symptomatic benefits for people with osteoarthritis, as well as delaying joint replacement in some. There have been published randomised controlled trials with interventions targeting structural components of cartilage (glucosamine sulphate) and bone (strontium ranelate). However, several limitations have been identified with the glucosamine sulphate studies, and it is unclear whether cardiovascular concerns will prevent approval of strontium ranelate for treating osteoarthritis. Randomised, placebo-controlled trials of adequate power and duration (related to the structural end point under consideration) should be undertaken to determine the benefits and side effects of agents with disease-modifying osteoarthritis drug potential for treating both hip and knee osteoarthritis (separately). Appropriate structural end points may include progression of radiographic joint space narrowing or MRI features of osteoarthritis. Associated clinical end points could include measures of pain, function and health-related quality of life. Studies should also include rates of subsequent joint replacement (preferably maintaining original blinding, even if extensions are open label). Later phase trials should include a health economic evaluation.

Source guidance details

Comes from guidance
Osteoarthritis: care and management
Number
CG177
Date issued
February 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 13/03/2014