Link between treatment for RA and osteoarthritis

[cathie]

Has anyone noticed a link between how good your RA is and how your osteo is? Since my anti-tnf has been halted (temporarily I hope) the joints where they think I have osteo have been significantly worse. My knee is really burning away. I'm preparing to meet consultant once the scan has been done next week and am trying to clarify things!

[helixhelix]

Every time I ask my consultant she tells me they aren't related....but I find it odd that joints where I now have osteo are ones that have flared most? And is it just coincidence that the osteo in my back has got much worse since the RA took hold? In your case it could be that if your RA is trying to make itself felt again then the joints where you have osteo damage are likely to be the most sensitive? For me the line between the two is a bit hazy anyway, as it all ends up as bits of me that don't works properly or just hurt! Pollyx

[cathie]

Yes that's about my way of thinking. It would seem to make sense that if joints/ body generally is inflaming then any other irritation would be worse. Thanks for this. I will keep searching for an answer and broadcast it!!

[Hidden]

Hi Cathie, When you talk about OA are they the same as 'wear and tear' arthritis, do you know? My rhumey nurse refers to this on some occasions when I have said different parts of my body are hurting.

[cathie]

I'm not sure if its exactly that but it could be called wear and tear...

[Hidden]

I don't know if there's a difference between wear and tear and secondary OA? My OA arrived when I had been given a Kenalog jag for my RA and its been quite aggressive in my fingers at the same time as the RA took hold of them. Hard for me to know which is which but I feel sure they are strongly interconnected because its too much of a coincidence otherwise - but not due to RA meds as I was still awaiting diagnosis at the time.

Also have it in my lower back L5 now apparently although its not there all the time. I did notice it seemed to improve in my back at the same time as I went up a dose with injectable MTX to 17.5 but this must be coincidence because I was told by rheumy that RA doesn't go for the back usually. Sorry can't help more than this but personally my hunch is that they are strongly connected for us - whatever the medics say. Tilda xx

[nottsexsportfanatic]

Very good and interesting question. I had no wear and tear signs until after diagnosis. I was diagnosed with ra one year ago and on my last visit my rheumy told me I have signs of oa in my hands. So from nothing to having both within a year does, to me, suggest a link. Just not sure how or whether it is meds related.

Look forward to learning more.

[cathie]

Ive sent a question to nras helpline so ill let you all know what they say. Its abeautiful day today so am going to take my achey joints for a wee walk to discover signs of spring!

[Pands]

Hi I know that I do have secondary osteoarthritis caused by the damage (extra wear and tear I guess) to my joints whist my RA wasn't under some degree of control. I had about 4 years where i wasn't on very much strong medication because of contraindications with pregnancy etc and I have a lot of residual damage now to wrists, thumbs, knees and feet and jaw (I sound a delight!). My consultant said last time I saw him that some of my joints probably aged 20-25 years in that 4 years in terms of the wear and damage caused over that short period... It really made me think. Best wishes.

[cathie]

This is what Sarah on the NRAS helpline said - very helpful and it confirms there is a link which is probably underresearched. I hope it helps someone else as well as me!

I’m sorry to hear that your pain is starting to return. Certainly inflammation may be the cause of this burning pain but as inflammation is a symptom of both RA and OA it would be difficult to say exactly which is causing this for you.

Having done a little research this morning is appears that the TNF-alpha cytokine does play a role in osteroarthritis (OA) and so there have been a small number of trials (mostly animal) looking at anti-TNF use in OA. I have copied below some relevant sections from studies and included a link to the full abstract if you would like to read further (unfortunately we are not able to access the full articles without subscription to these journals).

“Although there is clear evidence that TNF-alpha plays a role in the pathophysiology of OA, only a few experimental trials have investigated the efficacy of blocking this pro-inflammatory cytokine in the treatment of OA. So far, the few studies available in humans using anti-TNF-alpha and IL-1 receptor antagonist are not remarkable, suggesting that further investigation and new therapeutic approaches are needed.”

link.springer.com/article/1...

“Although we detected no statistically significant improvement in the number of tender joints, grip strength, disability, pain, or global disease assessments, trends suggested modest improvement in all efficacy measures. CONCLUSION: This small open-label study of patients with EOA (erosive osteoarthritis) demonstrated that adalimumab was well tolerated. Treatment with adalimumab for 3 months did not significantly improve the signs and symptoms of EOA and most patients did not achieve an ACR20. Trends suggested improvement and individual patients had some benefit.”

jrheum.org/content/34/6/132...

“Furthermore, studies in animal models have illustrated the potentially beneficial effects of anticytokine therapy with monoclonal antibodies or receptor antagonists, although local rather than systemic delivery would be necessary for the largely localized OA in humans.”

informahealthcare.com/doi/a...

So it appears that there is limited evidence that anti-TNFs would benefit those with OA but further research is needed in this area. The first study quoted above took place in 2010 so this seems to be quite a new area of research still, and if the anti-TNFs only offer limited benefit to those with OA it may be difficult to justify the cost of using these drugs to treat OA.

It may be worth speaking to Arthritis Care (who specialise in OA) about your symptoms. This may give you an idea of if the symptoms you are experiencing currently sound like they may be as a result of osteoarthritis, and if they do not this may give you an idea of what to bring up with your consultant when you see them. Arthritis Care may also be aware of the latest research into the use of anti-TNFs for osteoarthritis.

Arthritis Care: arthritiscare.org.uk/Home

Helpline: 0808 800 4050

I hope this information has been useful and helped to clarify things a little.

[petalnumber2 in reply to cathie]

Hi all,

Well I've read the thread of conversation and information with great interest, because I too have wondered about the significance of OA with RA.

I've had OA for many years and during that time I've had flare ups that involved so many joints at the same time including jaw and ribs along with all the other usual joints like fingers, thumbs and knees. However, since being on MTX I've not had a repeated experience of such an overall flare up. But then I wonder if the OA is just intermingled with the RA? The only difference between OA & RA that I have notice is that RA is simetrical, both my ankles, both wrists etc and of course the swelling of joints in RA.

I'm inclined to think that MTX is helping both! Best wishes x

[selina]

Sounds like more research needed. Just been told today that my painful knees are due to OA and pain in 1 elbow due to 'tennis elbow' (haven't been near a racket since school days - my husband says probably because we went to Wimbledon last year!) It's all so confusing & at the end of the day all I care about is getting the right treatment for each condition - cos it hurts!

[cathie]

Sorry about your pains. What interests me is whether successful treatment for RA helps OA. I think there's enough evidence that there is a connection, though noone can really be sure what it is!