World Arthritis Day: Advances in stem cell and gene therapy offer new hope for arthritis treatment

Approximately 18 million people globally lived with rheumatoid arthritis in 2019, with women accounting for a staggering 70% of those affected, according to the World Health Organization (WHO).

The disease also disproportionately affects older people, with 55% of sufferers aged 55 years or older. A significant proportion – 13 million – experience moderate to severe symptoms, which could greatly benefit from rehabilitation interventions.

Dr Abhishek Bansal, Senior Orthopaedic Surgeon, Pristyn Care shared insights with Firstpost on various aspects surrounding these issues.

What is arthritis and its prevalence locally/globally?

Arthritis refers to a group of over 100 conditions that cause inflammation and stiffness in the joints. It causes pain and loss of movement in millions, having more than 350 million cases diagnosed worldwide. According to a study “Prevalence of osteoarthritis in India: A systematic review and meta-analysis” published in 2019, 62.35 million people in India suffer from osteoarthritis.

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What are the common types of arthritis, and what are the symptoms associated with each?

Osteoarthritis is the most common form of the disease and is caused by degenerative wear on cartilage, making joints sore and stiff. Rheumatoid arthritis is an autoimmune illness that creates inflammation, swelling, and pain in the joints. A form known as psoriatic arthritis occurs in some people with psoriasis who also begin to experience inflammation in the joints besides skin symptoms. Symptoms across the different types include joint pain, swelling, stiffness, and limited mobility; however, these symptoms vary from relatively minor to significant.

How has the global/local prevalence of arthritis evolved, and what are the current trends in arthritis-related joint surgeries?

The worldwide prevalence is increasing, partly due to population aging and lifestyle factors, such as increased prevalence of obesity and reduced activity levels. There are increasing demands for joint replacement surgeries, especially for total knee and hip replacements. Trends are towards early intervention and minimally invasive techniques with faster recovery and better outcomes. In India, arthritis prevalence has surged due to aging, lifestyle changes, and obesity, with osteoarthritis being the most common type. This rise has led to an increased demand for joint surgeries, particularly knee replacements. Current trends emphasise minimally invasive techniques, quicker recovery times and better rehabilitation, making joint replacement more accessible across the country.

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What role does lifestyle modification play in arthritis management and how effective are these changes in slowing the disease’s progression?

Lifestyle changes become critical components of arthritis management. An appropriate diet, low-impact exercise, and management of stress behaviors will alter these to reduce inflammation, strengthen the muscle around the joint, and improve mobility to avoid worse disease outcomes and lessened need for medication or surgery.

What are the benefits of minimally invasive techniques in total knee replacement surgery, and how do they compare with traditional methods in terms of recovery time and long-term outcomes?

Minimally invasive total knee replacement techniques need fewer cuts, less muscle disruption, and quicker recovery times than traditional surgery. Patients often report less pain, quicker return to daily activities, and fewer complications, although long-term results in regard to joint function and durability are comparable to conventional methods.

How effective is arthroscopy in treating osteoarthritis, and what are its limitations in preventing or delaying joint replacement surgery?

Arthroscopy has been able to effectively treat a variety of conditions like meniscal tears, ligament injuries, cartilage damage and bone spurs resulting from osteoarthritis. This effective minimally invasive procedure prevents the deterioration of hyaline cartilage (a smooth, glass-like tissue that covers the ends of bones in joints, providing a cushion and reducing friction during movement), which otherwise could lead to end-stage joint failure. However, this capability could prove limiting in preventing or delaying joint replacement surgery.

What advancements have been made in arthroscopy, and how do they help in avoiding or delaying joint replacement surgery?

Joint-related problems are better diagnosed and repaired with the help of advancements in arthroscopy such as improved imaging techniques and precision instruments. Such technology may delay the surgery for joint replacement; however, their efficacy would depend on the severity of arthritis.

What are the potential risks and complications associated with arthroscopic surgery, and how can they be managed?

Arthroscopic surgery has risks, which include infection, blood clot, and nerve or blood vessel injury, among others. These complications are rarely seen. Such complications can be controlled with careful surgical technique, postoperative care, and early intervention when problems arise.  Risks in rehabilitation and proper wound care can also be avoided.

When is total knee replacement surgery recommended for arthritis patients, and what factors determine whether it’s the best option?

Total knee replacement is recommended if the condition has severely impaired mobility, led to chronic pain, and other forms of treatment have failed. Such considerations as age and health of the patient in addition to how much the joint may have been damaged and to what extent they can continue participation in rehabilitation post-surgery are considerations for whether to proceed with surgery.

How effective is joint fusion surgery for rheumatoid arthritis, and how does it affect long-term mobility and quality of life?

While medical treatment can play a crucial role in relieving severe pain in rheumatoid arthritis, surgical treatment is occasionally needed. It might involve joint fusion, with bones of the joint brought together so that there is less pain; however, this does reduce mobility at the joint. Though this would not improve freedom of movement in daily life, it might lead to an overall improvement in the quality of life by reducing disabling pain.

Can you discuss the role of synovectomy in managing rheumatoid arthritis, and in what cases it is recommended?

Synovectomy is performed by a surgeon which involves removing part of the inflamed synovial lining surrounding the joint, and this is mostly in early-stage rheumatoid arthritis patients with localized inflammation that does not respond to drugs. It reduces pain and slows down the damage to the joint, although it’s unlikely to stop the disease long-term.

How might advancements in stem cell therapy or gene therapy impact future arthritis treatments?

One of the most promising approaches for cartilage regeneration and reorganization of immune responses in the case of arthritis is through stem cell therapy (involves utilising undifferentiated cells to repair or replace damaged tissues, offering potential treatments for various degenerative diseases) or gene therapy (entails modifying or replacing defective genes within an individual’s cells to treat or prevent genetic disorders.). They can even halt the progression of the disease or turn into another disease, thus stopping the eventual requirement for a joint replacement. It is something still in experimental stages with much research needed before they become mainstream treatments.

What role do emerging technologies like AI and wearables play in arthritis diagnosis and management?

Artificial and wearable technologies are indeed a harbinger for the future care of arthritis. AI can analyse imaging data to improve early diagnosis and treatment planning. The wearable devices monitor the movement of the joint along with the level of physical activity to provide some immediate feedback both to the patient and the doctor for the overall enhancement of the treatment and rehabilitation strategy.