ACR 2021: 8 New Things to Know About Osteoarthritis

You can participate in research studies about arthritis by using our ArthritisPower app to join our patient-centered research registry.

At the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting this year — ACR Convergence 2021 — more than 16,500 attendees and 600 speakers from more than 100 countries gathered virtually to share the latest research and address the most pressing issues for people living with osteoarthritis. 

The CreakyJoints team soaked it all in — listening, watching, and learning so we could bring you the most relevant information to ensure you know what you need to better manage your condition and get better care.

We combed through hundreds of studies, attended sessions from top osteoarthritis experts, and asked our team of patient and physician advisors to share the osteoarthritis updates they deemed most important for patients.

The result: Our curated, patient-friendly guide to osteoarthritis research and trends from ACR 2021. For more research breakthroughs from ACR 2021, check out our main guide: 100+ Arthritis & Rheumatic Disease Updates You Need to Know.

1. Non-drug therapies like physical therapy are underutilized in patients who should take precaution with NSAIDs

It’s pretty standard for people with knee and hip osteoarthritis to take non-steroidal anti-inflammatory drugs (NSAIDs) or opioids to manage OA pain.

In fact, “roughly 50 percent of people with OA are prescribed NSAIDs and more than 50 percent are prescribed opioids,” Boston University rheumatologist Jean Liew, MD, told CreakyJoints.

But what about those patients who can’t use these drugs due to contraindications or the need to take precautions because of comorbidities? Are we underutilizing other first-line approaches, like physical therapy (PT), in this group?

This study by researchers at Boston University School of Medicine aimed to assess differences in patterns of NSAID, opioid, and physical therapy (PT) among more than 30,000 newly diagnosed patients with knee OA (21,682 people) and hip OA (9,124 people). Nine percent had NSAID contraindications (should not use NSAIDs at all) and 22 percent NSAID precautions (should be careful when using NSAIDs), explained Dr. Liew.

The findings: “Physical therapy use was slightly lower among those with NSAID contraindications or precautions,” says Dr. Liew. “In adjusted analyses, those with contraindications or precautions to NSAIDs were at 1.2 to 1.5 times higher risk of opioid prescriptions than those without, while use of physical therapy was not increased for any group.”

So what does this mean for you? If you can’t safely take NSAIDS and your physician prescribes opioids, it’s a good idea to also ask about physical therapy. It’s an alternative treatment option that is often underused for at-risk patients.

2. People with hip OA may change their gait in ways that can lead to walking deficits and possibly arthritis in other joints

If you have hip osteoarthritis, it’s likely that you’ve relied on other muscles or parts of the body at one time or another to compensate for the pain and fatigue in your hips. But can this type of movement compensation lead to deficits in physical performance, muscle, strength, and fatigue over time?

Researchers at Salt Lake City Health Care System and Utah University studied 35 patients with end-stage hip osteoarthritis to determine if trunk movement compensation had a negative influence on physical function and fatigue.

After measuring the biomechanics of the patients, using a six-minute walking test, researchers found that weaker hip abductor muscles led to more compensation with excessive torso movement when walking. This could be a potential mechanism for accelerating arthritis onset in other joints, noted researchers.

3. Patients want to walk better and without gait aids post knee replacement surgery

What do knee osteoarthritis patients want out of surgery?

In a University of Toronto study, nearly 300 patients were surveyed to determine their expectations when it comes to walking improvements after a total knee replacement (TKA) surgery.

According to the study, 97.5 percent of patients want surgery to improve their ability to walk (preferably medium-to-long distances). Of those who use a gait aid (such as a cane), 84 percent want surgery to remove the need for an aid. However, when surveyed 12 months after their surgery, only two-thirds of patients reported the ability to walk long distances post-surgery.

It’s a good reminder to talk to your health care provider about your surgery goals and expectations, this way you’re prepared mentally and physically post-knee replacement.

4. Knee replacement surgery help improve your mental health

It’s certainly not news that there’s a link between physical pain and mental health — but if you treat the pain of knee OA with joint replacement surgery, will depression and anxiety improve too?

Research from the same University of Toronto team suggests the answer is yes. Researchers assessed self-reported pain scores as well as levels of anxiety or depression in 1,259 patients with knee osteoarthritis before and 12 months after total knee replacement surgery: More than two-thirds of participants reported a decrease in anxiety and depression after surgery. Perhaps not surprisingly, patients with less self-efficacy and worse knee pain post after surgery did not show mood improvements.

The takeaway: Living with painful symptoms takes a mental toll, so it’s important to work with your health care provider to explore treatment options to get the pain relief you need.

5. CBD did not show pain-relieving effects for patients with hand OA and psoriatic arthritis.

Can cannabidiol (CBD) ease pain symptoms in hand osteoarthritis or psoriatic arthritis? New research casts some doubt.

To determine if CBD has any analgesic [pain-relieving] effects, researchers enrolled 129 patients with hand osteoarthritis and psoriatic arthritis without active inflammation. For the placebo-controlled study, participants were given 20 to 30 mg of CBD or matching placebo for 12 weeks.

The results: There was no significant difference in pain, sleep quality, depression, anxiety, or pain catastrophizing after 12 weeks on CBD. In fact, in patients who showed a greater than 50 percent decrease in pain, 25 percent were given CBD and 27 percent were given a placebo, rheumatologist and epidemiologist Richard Conway, MD, said in a RheumNow video.

“CBD has been investigated for its potential effects in anti-inflammatory and pain control across a variety of diseases, including rheumatic diseases,” said Dr. Conway. “CBD at these doses had no effects as far as analgesic [pain relieving] benefit [for patients]  — and there’s a high placebo rate so it’s likely that some patients using CBD will find an improvement.”

6. Managing both type 2 diabetes and osteoarthritis can be tricky for patients

Research shows that people with type 2 diabetes are more susceptible to developing osteoarthritis, partly due to obesity and aging, which are shared risk factors for both conditions. However, there’s limited information when it comes to how patients feel about managing these two chronic conditions together.

An ACR study by researchers at the University of Toronto and Women’s College Hospital explored experiences of people with knee OA and type 2 diabetes. The researchers recruited 18 patients (who had lived with both conditions for roughly a decade or more) and conducted semi-structured telephone interviews.

Here are a few key findings: ​​

• OA pain makes it difficult to engage in prescribed physical activity and get sleep, which patients think negatively impacts their blood sugar control.
• Patients prioritize osteoarthritis over diabetes care because it reduces their ability to participate in activities and negatively impacts emotional well-being.
• On the other hand, doctors pay more attention to diabetes than osteoarthritis, so patients must coordinate and advocate for their care.

The researchers hope that these findings lead to “greater recognition by health professionals of the impact of knee OA in persons with type 2 diabetes,” which, in turn, can improve both diabetes care and quality of life.

7. People with atopic disease (asthma and eczema) have an increased risk for osteoarthritis

Studies have shown that atopic disease is a risk factor for rheumatoid arthritis and inflammatory bowel disease — and now new research suggests a link with osteoarthritis.

A large study used data from electronic medical records databases to identify 35,097 patients with asthma, 77,854 patients with atopic dermatitis (eczema), 4,395 patients with both conditions, and 2,242,901 control patients without any atopic disease. Among the findings, they observed an 84 percent increased risk of people with both asthma and atopic dermatitis developing osteoarthritis compared to the general population.

“Our findings provide further evidence that allergic pathways may contribute to the development of OA, and future interventional studies could consider targeting these pathways for the treatment of OA,” wrote researchers.

8. Skipping stair climbing is linked with a decrease in function in knee OA

Stair climbing may be the last thing you want to do when you have painful knee osteoarthritis, but this everyday activity might be key to your future health. 

A new study of patients with knee OA found that lack of stair climbing may increase the risk of worsening function. This includes having slow gait speed, which has a strong relationship with hospitalization and early mortality.

Researchers from the University of Delaware and Massachusetts General Hospital found that adults with knee OA who decreased their stair climbing over two years (below five days per week), or who had fluctuating patterns of stair climbing were at risk for developing a slow gait speed.

“Given that stair climbing is a high-demand functional task, the stark increased risk in worsening function (via slow gait speed) over a short period of time is of concern,” wrote researchers. “Adults with knee OA who report decreased stair climbing are prime targets for early intervention to prevent future loss of general function.”

You Can Participate in Osteoarthritis Research Too

If you are diagnosed with osteoarthritis or another musculoskeletal condition, we encourage you to participate in future studies by joining CreakyJoints’ patient research registry, ArthritisPower. ArthritisPower is the first-ever patient-led, patient-centered research registry for joint, bone, and inflammatory skin conditions. Learn more and sign up here.