A widely used diabetes medication may offer relief for people suffering from knee osteoarthritis (OA) and obesity, potentially delaying the need for knee replacement surgeries, according to a recent study led by Monash University.
Metformin, a common treatment for type 2 diabetes, has been shown to reduce knee pain in individuals with symptomatic knee OA and excess weight, as detailed in a clinical trial published in JAMA. This community-based study used telehealth methods to assess the impact of metformin, comparing its effects with a placebo.
The trial involved 107 participants—73 women and 34 men, with an average age of 60—who did not have diabetes but experienced knee pain due to osteoarthritis. Over six months, some participants were given up to 2,000 mg of metformin daily, while others received a placebo. Pain was measured on a scale of 0 to 100, with 100 representing the most severe pain.
Results showed that those taking metformin reported a significant reduction in knee pain, with a 31.3-point decrease on the pain scale, compared to 18.9 points for the placebo group. This difference, while moderate, suggests that metformin could serve as an effective option for pain management in knee OA patients dealing with obesity.
Professor Flavia Cicuttini, the study’s lead researcher and head of Monash University’s Musculoskeletal Unit, explained that this finding provides a new, affordable method to manage knee OA pain. She emphasized the limitations of current treatment options, which often include lifestyle changes like exercise and weight loss—approaches that many patients struggle with—and medications that may offer minimal relief or pose safety concerns.
Despite advances in treatment, no new medications for osteoarthritis have been approved in Australia since the late 1990s, leaving knee replacements as the primary solution for many. However, Cicuttini pointed out the growing issue of patient dissatisfaction with knee replacements, particularly when performed at early stages of OA. Studies show that up to 30% of patients are unhappy with their knee replacement results, especially if the procedure is done prematurely.
Early knee replacements not only result in higher dissatisfaction but also come with increased costs, approximately $70,000 compared to the $20,000 for initial surgeries. Furthermore, repeat surgeries often yield less favorable outcomes. Cicuttini stressed that delaying knee replacements could improve both patient satisfaction and long-term success.
Metformin presents a potential alternative for general practitioners (GPs) to offer patients, alongside other treatments like weight management and physical activity. Its low cost and safety profile make it a viable option for wider use. The drug works by addressing low-grade inflammation and metabolic pathways that play a role in knee OA.
“We are exploring how metformin can be integrated into the management of knee OA, particularly for patients who may benefit from delaying knee replacement,” Cicuttini noted. “With its broad accessibility and proven safety, metformin could be administered via telehealth, making it available even in remote areas.”
Currently, the research team is collaborating with healthcare professionals to introduce metformin into treatment pathways for knee OA. While the drug is not yet officially approved for this purpose, patients may discuss it with their doctors as an off-label option.
As the study suggests, metformin’s ability to reduce pain and increase mobility could help many patients avoid premature knee replacements, potentially transforming the approach to managing knee OA.
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