Arthritis: Cheap drug reduces hip and knee replacements

Arthritis patients could be given a £1-a-day drug to delay progression of the disease and reduce the need for hip and knee replacements, a study has suggested.

The drug Strontium ranelate, marketed as Protelos, is used for people with the brittle bone disease, osteoporosis, because it prevents the bone dissolving and stimulates growth.

It has also been found to be the first drug that can slow the progression of osteoarthritis.

The study, presented at the European Congress on Osteoporosis and Osteoarthritia in Bordeaux, showed that Protelos reduced deterioration of knee-joint cartilage in a group of arthritis patients by a third over three years. It also led to a significant reduction in pain and improved day-to-day mobility.

Experts said the findings could change the way arthritis is treated.

An estimated 8.5 million people in Britain are affected by osteoarthritis which results in the gradual wearing away of cartilage and bone.

Until now, pain management and physiotherapy has been the only available treatment short of surgery. Each year around 1,40,000 hip and knee replacements are performed on the NHS in England and Wales at a cost of more than £1 billion.

The lead author, Professor Cyrus Cooper, from Oxford and Southampton universities, said: "This is a major breakthrough. Osteoarthritis is a painful and debilitating condition, and for over 20 years we have been searching for a treatment that would allow us to alter the course of the disease, rather than just manage the symptoms.

"The results could totally change the way we treat osteoarthritis. For the first time we have a treatment that can slow the development of this debilitating disease and could reduce or even eliminate the need for expensive and painful joint replacement surgery."

The trial involved 1,683 mostly female arthritis patients with an average age of 63 who were randomly treated with either 1g or 2g daily doses of Protelos, or a dummy drug. It was found that the 2mg dose slowed progression of the condition so that after three years there appeared to be only one year's worth of decline.

Prof Cooper said the drug produced an almost 50% reduction in the frequency of rapid progression. Patients who are rapid progressors have a five-fold increased risk of needing joint replacement.

"You would expect it might have an impact on joint replacement rates," said Prof Cooper.

The French manufacturer Servier is understood to be applying for a new licence so it can be used in osteoarthritis as well as osteoporosis.

Judith Brodie, chief executive of Arthritis Care, said: "Many people with osteoarthritis live for years in great pain before eventually needing joint replacements. This is the first study to show benefit from strontium ranelate so it is early days, but if there is a treatment which can hold back the disease, delay knee replacements and help people to live more active lives for longer, then it will be good news for the millions of people in the UK with this debilitating condition."

Professor Alan Silman, from the charity Arthritis Research UK, described the findings as an "exciting development".

He said: "Although it doesn't reverse osteoarthritis, it slows down its progression in terms of X-rays, and appears to have a beneficial effect on pain, although the extent of this is still unclear.

"This the first time that a drug has been shown to slow progression of osteoarthritis, as existing treatments for osteoarthritis just focus on symptoms."