Abstract
To determine the efficacy and safety of risedronate in patients with knee osteoarthritis (OA), the British study of risedronate in structure and symptoms of knee OA (BRISK), a 1-year prospective, double-blind, placebo-controlled study, enrolled patients (40–80 years of age) with mild to moderate OA of the medial compartment of the knee. The primary aims were to detect differences in symptoms and function. Patients were randomized to once-daily risedronate (5 mg or 15 mg) or placebo. Radiographs were taken at baseline and 1 year for assessment of joint-space width using a standardized radiographic method with fluoroscopic positioning of the joint. Pain, function, and stiffness were assessed using the Western Ontario and McMaster Universities (WOMAC) OA index. The patient global assessment and use of walking aids were measured and bone and cartilage markers were assessed. The intention-to-treat population consisted of 284 patients. Those receiving risedronate at 15 mg showed improvement of the WOMAC index, particularly of physical function, significant improvement of the patient global assessment (P < 0.001), and decreased use of walking aids relative to patients receiving the placebo (P = 0.009). A trend towards attenuation of joint-space narrowing was observed in the group receiving 15 mg risedronate. Eight percent (n = 7) of patients receiving placebo and 4% (n = 4) of patients receiving 5 mg risedronate exhibited detectable progression of disease (joint-space width ≥ 25% or ≥ 0.75 mm) versus 1% (n = 1) of patients receiving 15 mg risedronate (P = 0.067). Risedronate (15 mg) significantly reduced markers of cartilage degradation and bone resorption. Both doses of risedronate were well tolerated. In this study, clear trends towards improvement were observed in both joint structure and symptoms in patients with primary knee OA treated with risedronate.
Highlights
Osteoarthritis (OA) is a chronic, progressive disease that affects weight-bearing joints such as hips and knees
Knee OA in particular is a major cause of morbidity, often resulting in knee replacement [1,2,3]
Costs associated with OA are high – in the USA alone in 1991, the annual cost of knee replacements was estimated to be more than one billion dollars [4]
Summary
Osteoarthritis (OA) is a chronic, progressive disease that affects weight-bearing joints such as hips and knees. The entire joint is affected by a complex combination of degradative and reparative processes, which alter the anatomy and function of articular cartilage, subchondral bone, and other joint tissues. Knee OA in particular is a major cause of morbidity, often resulting in knee replacement [1,2,3]. Costs associated with OA are high – in the USA alone in 1991, the annual cost of knee replacements was estimated to be more than one billion dollars [4]. OA is normally the result of an interplay between systemic (e.g. age, obesity) and local (e.g. sports injury) factors that affect the joints of the body.
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