hile it is true, I have covered this before here in the PAR catacombes....

I reckon this is still worth a new thread because...

1) A lot of people are new to us, and have no idea what an Osteophyte is!

2) This is a cross post across platforms...yep, I just posted this on Reddit, I'm building my profile over there, and while, of course, Hotcopper is my home base...and always will be...you guys are like 600 odd at max, over there, well my last two posts are in the multiple thousands....the second latest post just hit 11,000 views, now that's worth pursuing....

3) Why do it? Why spend hours on research, hours on editing, and checking? Because...

Help me to help you.

Yeah, the more people that read about iPPS...the more that understand the potential. At the end of the day we want longer term supporters. Yeah there will be some that trade it and good for them. But I want cornerstone investors...at least SOME shares that are genuinely held for a long, long time. It's potentially good for them if it works out, but also potentially good for the Co if there is less churn and turn over.

Note: The formatting below isn't going to be ideal, the best way to read it is via the original post, here is the link:

https://www.reddit.com/r/Osteoarthritis/comments/1mxxz6n/oa_and_osteophytes/

I dunno how many of you will go over there to check it out, but if you do spend the effort, please upvote it. The more it features, the more we get exposed and I reckon that's only a good supportive gesture that should at least somewhat translate to positive exposure for us!


Please now, enjoy!


Oh and before I forget, DYOR!


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OA and Osteophytes

This post is in response to a request by the Reddit member, Maclardy44 in regards to Lumbar OA, Osteophytes and Pain. Usual disclaimers; I'm not a Doc, this is not investment or medical advice and probably doesn't constitute any/much entertainment value either, do your own research applies.

DEFINITIONS

Osteoarthritis is a chronic (ongoing) disease that results in the breaking down of cartilage. Cartilage is the cushioning between joints that allow bones to effortlessly glide over one another. It also has shock-absorbency properties particular in joints like the knees.

Thus, lumbar OA is the deterioration of the cartilage between each joint of the spine, particularly the lower part above the pelvis.

In fact the presence of osteophytes feature in the KL grading of OA.

Osteophytes can progressively feature in incremental OA grading.

But what are Osteophytes?

Osteophytes are bony spurs that can grow off the bone. Typically they develop when cartilage starts to deplete and the rubbing of bone on bone creates these spurs. But these spurs can develop well before it is 'bone on bone' typically as a result of cartilage breakdown, inflammation and/or injury. In of itself, they may not cause pain however, if they rub against a nerve, that's when pain manifests!

Remember, the spine is quite flexible and has a number of different types of movements. Also realise that these osteophyte protrusions aren't just restricted to the lumbar region.

So do they always cause pain? How do they cause pain?

Not always. The main ways they cause pain is that they can rub or literally grow into nerves or compress nearby tissues or joint structures.

They can restrict functioning of the joint.

Have you seen how they look?

Well, here is a pic:

Ahh may not look like much (see arrows above) but these little 'smooth' bumps can play quite a role in the unwanted concert of pain, particularly as OA manifests.

While they are more common in older people, 60 and over, younger people can develop them too.

There is a link between OA and these bony spurs. In fact, joint damage itself can cause these spurs. Once your cartilage starts to become hard and lose the flexibility, then you can be more susceptible to these osteophytes.

KNOCK ON EFFECTS

A number of problems can develop once these spurs occur:

• Reduce flexion

• Obstruct or press against nerves causing pain

• They can rub against other bones and tissues causing pain and further destruction

• Bumpy areas can protrude (specially the fingers and toes)

• Numbness and weakness can also occur

• Pain near the affected joint

• Reduced ROM

• Stiffness

• Tendinitis can result

• Tenon tears.

Remember, it is usually not the absence or degradation of cartilage itself that causes the pain, as was observed in one paper illustrating that it is the osteophytes that are a mediator between cartilage morphology and changes in knee symptoms in patients with knee osteoarthritis:¹

"Our findings indicated that cartilage was not the direct source of knee pain and knee dysfunction but indirectly through osteophytes".

CURRENT REMEDIES

So what can you do when pain sets in when cartilage wears out?

What remedies are available for OA?

The basic steps are going to apply here:

1. Look at your weight, are you a bit on the heavier side? Can you reduce your weight slowly and gradually?

What is ideal is to replace too much fat with muscle. You want more muscle and less fat. It's the job of the muscles to :

-Help you move, in lots of different directions

- Helps to stabilise the joint,

- Helps to protect the joint

- Helps in coordination
.

2) Look at your diet

Are you eating good foods that are less likely to add to the inflammation?

Alcohol consumption also helps to aggravate inflammation, moderation is better!
.

3) Exercise
.

Moderate and gradual build up of the right kinds of exercise will only help. Of course speak to a professional before embarking on any new activities to see if they are right for you. Your aim here is to deliberately micro damage your muscles!

Huh?

Yes, because in exercising this causes micro tears but it is the subsequent REPAIR that fortifies and strengthens the muscles. Have stronger muscles that surround the joints and you get joints that can do more...can be more supportive, more flexible and more able to cushions shocks. The stronger muscles assist the joints and protect them. This is what you want.

It's counter intuitive, when you are in pain, the last thing you think about is any exercise, but moderate, correct exercise can actually alleviate some pain. (Consult your medical professional before undertaking any new exercise to see what is right for you!).

Now, despite all of the above, there are many that will still be in pain and discomfort, that will suffer a loss of function. The next step will inevitably be pharmacological interventions.

Let's take a brief look:
.

NSAIDS - Non Steroid Anti Inflammatories - sure, good for some pain relief, not designed to be taken for longer periods of time! Can be quite destructive!

OPIOIDS - Next level pain relief but can be highly addictive and over time, can be a diminishing utility. Be very aware of this class. I don't need to tell you how many people die each day due to misuse!

CORTICOSTEROIDS - May give you a decent 3 months of typical pain relief but it comes at a cost, an increased chance of adding to joint failure over time with more and more shots! Be very aware of this class of intervention!

A FUTURE REMEDY?

Just before I introduce a possible future remedy, take a look at this quote:

"Osteophytes do not regress."

--D.M. Yousem - American Journal of Neuroradiology December 2016.


.

Once you have them, in the vast majority of cases, they do NOT rescind....the body doesn't have a natural mechanism to dissolve or remove them.²

So what is potentially on the horizon in terms of future treatments?

What future treatments can we expect?

It's totally early days yet but there appears to be a drug that's relatively safe, has duration, has been in use for decades, has a decent safety profile and is showing some halting of the increase in osteophytes and even some regression. But we have to be cautious. The data so far, while it came from a well controlled double blinded study, n was very low. The real test will be at scale ie in a Phase 3 and then of course, if it gets a full licence, how it performs out there in the world at full pelt.

The thing I like is that there were some solid evidence of Bone Marrow Lesion regression, this occurred in both Phase 2b trials utilising SubQ Pentosan. Reduction and rescinding of BMEL can possibly reduce osteophytes. Certainly there is a link between the increase of the two in terms of OA progression⁴:

"Bone marrow lesions (BMLs) and effusion-synovitis were also associated with knee symptoms. We reported that higher grades of baseline osteophyte were positively associated with increased effusion-synovitis and BMLs over time. In another large population-based cohort study we reported that both baseline BMLs and effusion-synovitis had significant associations with the worsening osteophyte over 2.6 years."

The drug I am taking an interest in is the naturally based complex sugar molecule, Pentosan. Particularly in the SubQ format..

DID YOU KNOW?

You all have heard of Aspirin right? Yes, very good, but what is the source of Aspirin? I'm guessing hardly 5% of the readers reading this Mozz post would know the source??

It's a natural source, ready?

Sitting down?

The bark of a Willow Tree!

What about Pentosan? Yep, you are right, it ALSO is naturally occurring...here is a clue:

What has a tree got to do with Pentosan?

The source of Pentosan is the bark of a European Beech Tree!

As an aside, not three hours ago, a very good mate of mine offered to send me a small Beechwood plant! The problem is that while I have room for a small plant in the backyard....these babies grow! Thank you to you-know-who, that is actually one of the best gestures and offers of a gift and it means a lot to me.

Getting back to Pentosan as a Phase 3...If it passes the current Globally harmonised Phase three trial, I believe it will have enormous potential. Potential in terms of symptomatic pain relief and function improvement but, importantly and for the first time ever seen ....potential in terms of positive structural implications. I'm talking Bone Marrow Regression, rescinding of Marginal Osteophytes and the material increase of cartilage volume and thickness, not over years, but over mere months. (Subject to Phase three data).

Thanks for the question...

.

Watch this space!


.

REFERENCES

1] https://www.oarsijournal.com/article/S1063-4584(22)00112-1/fulltext#:~:text=Purpose:%20Articular%20cartilage%20is%20a,were%20analyzed%20as%20a%20cohort.

2] https://my.clevelandclinic.org/health/diseases/10395-bone-spurs-osteophytes#:~:text=Bone%20spurs%20don't%20go,surgery%20for%20your%20bone%20spur.

3] https://www.medicalnewstoday.com/articles/319323#:~:text=When%20arthritis%20affects%20the%20lower,arthritis%20may%20be%20the%20cause.

4] https://www.sciencedirect.com/science/article/pii/S1063458421008141#:~:text=Bone%20marrow%20lesions%20(BMLs)%20and,effusion%2Dsynovitis%20was%20still%20unclear

5] https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/8-ways-exercise-helps-joints

6] https://www.thetutuguru.com.au/shop/beech-tree/?srsltid=AfmBOooR2mFdSkPwKN7XLRjiPSXJuJ5wcdlpx9BM2csXodaZm0XUnX1p