Osteoarthritis may be ‘inherently’ tied to neuroplasticity


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DESTIN, Fla. — “Sprouting” of new nerve endings in certain areas of the knee could be a key to understanding osteoarthritis and developing new treatments, according to a speaker at the Congress of Clinical Rheumatology East.

“Neuroplasticity is a new finding in the disease that might be, inherently, the disease,” Ann-Marie Malfait, MD, PhD, professor of medicine at Rush Medical College, told attendees.



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“Neuroplasticity is a new finding in the disease that might be, inherently, the disease,” Ann-Marie Malfait, MD, PhD, professor of medicine at Rush Medical College, told attendees. Image: Justin Cooper | Healio

According to Malfait, research her lab has performed on mice with experimental OA has demonstrated “a sprouting of nociceptors” in areas of the knee not observed in healthy mice, particularly the medial compartment and subchondral bone.

“New nociceptors are growing where there weren’t any before,” she said. “I think that’s an important concept to know when we are dealing with a diseased knee, that the nerves are in different places than a healthy knee, if we want to design treatments.”

Malfait stated she is now working on “a very large project” funded by the NIH in which knees from a diverse range of people with OA are being examined with the aim of “really mapping the innervation of the knee [to] see what’s happening there.”

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Ann-Marie Malfait

She added that similar changes have previously been observed in humans, noting imagery that another research team collected from the knee of a man aged 52 years with OA, which she said showed nerves associated with pain “digging into the deeper layers of the once-aneural cartilage.”

Nerve growth factor was also detected in the channels, said Malfait, outling the rocky path of nerve growth factor as a treatment target for OA so far. She added that anti-nerve-growth-factor drugs, such as tanezumab (Eli Lilly, Pfizer), “are very good, but the associated risk for joint destruction, rapidly progressing osteoarthritis, is too great.”

“I think, still, that nerve growth factor is really something that we should pursue,” she said. “But the question is, how can we do this safely?”

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