Once a month jab could ease pain of arthritic knees

A new type of drug could be a game-changer for millions of Britons with chronic knee pain.

The medication, administered as a once-a-month jab, appears to have none of the side-effects associated with widely used painkillers such as ibuprofen.

It works by blocking a compound that supports nerve cells involved in transmitting pain, stopping them working properly.

More than 600 people with knee osteoarthritis are taking part in clinical trials of the UK-developed drug, which researchers hope may also be effective for other chronic pain conditions.

Osteoarthritis, or wear and tear arthritis, occurs when the protective cartilage on the end of bones breaks down over time, causing pain, swelling and problems moving the joint as bone rubs against bone.

The knee is the joint most likely to be affected by osteoarthritis, accounting for just over half of all cases of the condition.

The joint can become red and swollen, and mis-shapen, leading to bow legs or bent legs, as the body searches for less painful areas of the joint to use.

Current treatments are aimed at reducing symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, relieve pain and reduce inflammation but carry the risk of stomach ulcers. Links have also been found to an increased risk of heart attack and stroke.

The new treatment, known as LEVI-04, developed by UK-based Levicept, is the first of a new class of drug known as neurotrophin receptor fusion proteins. These work in a different way from other painkillers, acting on a compound called nerve growth factor (NGF).

Osteoarthritis, or wear and tear arthritis, occurs when the protective cartilage on the end of bones breaks down over time, causing pain, swelling and problems moving the joint as bone rubs against bone

Ibuprofen blocks an enzyme called cyclooxygenase (COX), which leads to anti-inflammatory and painkilling effects. NGF plays a key role in the growth and maintenance of the nerve cells that send messages about physical sensations, such as pain and temperature, to the brain.

Blocking it completely would ease pain but as nerve cells have other functions, such as repair, this would be detrimental.

The new drug gets around this by targeting only excess nerve cells, mopping them up and leaving enough for healthy functions.

About 620 people are taking part in a clinical trial of the drug at centres in Europe and Hong Kong. It will be compared to a placebo, and participants’ pain levels will be measured over 17 weeks.

There are hopes that LEVI-04 could delay the need for joint replacement surgery.

Commenting on the new drug, Mike McNicholas, a consultant orthopaedic surgeon at Liverpool University Hospitals, said: ‘This treatment aims to use a monthly injection to reduce the crippling pain of knee and hip arthritis and would be preferable to the patients taking several tablets at different times of the day.

‘But nerves also function to protect the joint from excessive forces and regulate blood flow. Responsible introduction will be needed with this treatment approach.

‘Results of this study should be viewed with caution. They may be on to something — but only time will tell.’

Could specially adapted shoes soon be offered to people with knee arthritis instead of joint replacement surgery?

The Apos shoes look like trainers but each has two adjustable convex rubber ‘pods’ at the front and back of the sole, which are calibrated to change walking style. This alters the centre of pressure in the knee join, reducing pain.

Last month, a National Institute for Health and Care Excellence committee recommended the footwear for patients with severe osteoarthritis, who are otherwise suitable for knee surgery. A final decision is expected in spring.

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Once a month jab could ease pain of arthritic knees: More than 600 people with knee osteoarthritis are taking part in clinical trials of the drug