Getting Younger Athletes With OA Back In The Game

Approximately 8.5 million people between 18 and 44 have been diagnosed with arthritis, according to recent statistics from the Centers for Disease Control and Prevention (CDC). Athletes may be particularly susceptible to developing osteoarthritis. The CDC notes those who suffer severe joint injuries, such as rotator cuff injuries or anterior cruciate ligament injuries, are six times more likely to develop OA.

Don Flinn, PA-C, who frequently sees OA in patients between the ages of 30 to 40, concurs. In his experience, he has noted that common causes of osteoarthritis are joint injury, intraarticular fractures or overuse of joints. He also cites previous surgery, especially meniscectomy, as a causative factor.

Emerging research suggests that arthroscopic surgery may be a promising option in the diagnosis and treatment of osteoarthritis (OA) in active, young adults. In a recent issue of Clinical Sports Medicine, a review of data found that techniques such as arthroscopic lavage and debridement “provide benefit in a significant percentage of patients.”

Flinn and Kevin Plancher, MD, say a combination of conservative and surgical techniques may be the most effective approach to managing OA in younger, active patients. In addition to arthroscopy, performing low-impact activities, such as yoga or water exercise, can be helpful for sports enthusiasts with arthritis as these activities can help maximize the range of motion in the joints, notes Dr. Plancher, an orthopaedic surgeon who has been a team physician for over 15 high school and college athletic teams.

When it comes to younger athletes with osteoarthritis, Flinn has found that arthroscopic debridement can be beneficial for these patients. He says other surgical procedures, such as osteotomies, total joint arthroplasties and resurfacing procedures, may be helpful.

Flinn, who is on the Board of Directors for the Oklahoma Academy of Physician Assistants, adds that he has found success with conservative therapies such as NSAIDs, analgesics, hyaluronic acid injections, corticosteroid injections and exercise therapy.

Celecoxib Gains New Indication For Ankylosing Spondylitis

Ankylosing spondylitis, a form of chronic inflammation of the spine and sacroiliac joints, affects over 400,000 people in the United States. Given the prevalence of this condition, clinicians may welcome a new indication for a familiar modality. Celecoxib (Celebrex, Pfizer) recently received FDA approval for treating ankylosing spondylitis. It is the sixth indication for the COX-2 inhibitor, according to Pfizer.

Andre Barkhuizen, MD, FCP, says celecoxib is an “attractive option” for ankylosing spondylitis as it provides good control of the inflammatory symptoms. He also notes celecoxib has “significantly fewer gastrointestinal side effects and complicated peptic ulcers than non-selective NSAIDs” when the medication is used on a chronic basis.

Dr. Barkhuizen cites a pivotal 12-week clinical trial in which patients with ankylosing spondylitis experienced no peptic ulcers when treated with celecoxib. In that same trial, Dr. Barkhuizen notes that two of the patients treated with naproxen experienced GI bleeding and one of those had a peptic ulcer.

Celecoxib is contraindicated in patients with a known sulfonamide allergy, according to Dr. Barkhuizen, an Associate Professor of Medicine, Arthritis and Rheumatic Diseases at Oregon Health and Science University. He also notes celecoxib affects the kidneys and can cause mild blood pressure increases and fluid retention. While Dr. Barkhuizen notes he has had a few patients with such problems, he says both conditions reversed when patients stopped taking the drug.

Dr. Barkhuizen also cautions that celecoxib has only undergone a 12-week study for signs and symptoms of ankylosing spondylitis. Given the preliminary results, Dr. Barkhuizen says “it is unclear if it will do anything to the chronic spinal fusion in this disorder.”

While he notes that patients with this condition are usually young with few risk factors for atherosclerosis, Dr. Barkhuizen recommends close monitoring of blood pressure and renal function when considering the use of celecoxib in patients with preexisting renal impairment or hypertension.