Times/News

If you are one of the 50 million Americans who is hobbled by osteoarthritis in your knees or hips, you know just how painful this degenerative condition can be.

And if you suffer from the debilitating tenderness of fibromyalgia, you also share a personal awareness of living with chronic pain.

Osteoarthritis - a progressive breakdown of cartilage in the joints until the bones rub against each other - is the most common form of arthritis.

It is a major cause of pain and disability in older adults.

Fibromyalgia is a chronic disorder that causes widespread pain and tenderness in the muscles and soft tissue. It also causes sleep problems, fatigue and other symptoms as well.

Persons with osteoarthritis or fibromyalgia often experience pain so severe that it disrupts their work and other daily activities.

The good news is that medical research continues to discover new treatments that promise to reduce pain and improve mobility and the overall quality of life for persons who suffer from either condition.

If you live with either osteoarthritis or fibromyalgia, you may keep track of these developments.

But what you may not know is that Dr. Barry Bockow, a rheumatologist at the Arthritis Northwest clinic in Burien, is a principal investigator in several nationwide clinical trials.

A physician at Highline Medical Center, Bockow is also Clinical Associate Professor of Medicine at the University of Washington.

"Our clinic has been and is on the forefront of arthritis/immunology research for 25 years," Bockow declared recently. "We have been a principle investigator in more than 85 clinical trials."

He said even the University of Washington "does not have access to some of these new meds."

One current trial in which Bockow is participating involves a promising new topical treatment for patients with osteoarthritis in their knees.

Medical professionals long have been concerned with the toxic effects that oral anti-inflammatory medications, he noted, including those prescribed for osteoarthritis, have on the gastrointestinal tract.

Responding to this problem, "several large pharmaceutical companies have developed new delivery systems" to avoid administering anti-inflammatory by mouth.

"One company has developed a NSAID (non-steroidal anti-inflammatory drug) spray to be applied topically to affected knees of patients with osteoarthritis," Bockow continued.

"It is hoped that the local application means less side effects."

This medication, known generically as voltaren and similar to Aleve, has been used orally for 20 years - but, until now, never as a spray.

All patients participating in this study through Arthritis Northwest - one of 20 investigational sites in the U.S. and the only clinic in the Northwest participating in the trial - receive free physician visits, free lab studies, free x-rays, free medication and reimbursement for travel expenses.

Lab studies and x-rays are done at Highline Medical Center.

The results of this study in participating patients is straightforward, Bockow said. "Either it works or it doesn't work.

"A lot of people like the delivery system," a spray instead of an oral medication, "and we haven't seen any [negative side effects]," he added.

Bockow predicted that within 10 years many moer drugs will be delivered topically.

"The majority" of patients with osteoarthritis in their hips are "doing well" in a second clinical trial in which Bockow is a principal investigator.

This study involves the injection of hyaluronic acid, which lubricates the joints but is reduced by "wear and tear" around a joint, into the hip joints of these patients.

Known as Synvisc(r), this compound has been approved by the U.S. Food and Drug Administration (FDA) and used with success clinically for eight years in the treatment of patients with osteoarthritis in their knees.

Now the company that developed Synvisc is conducting the study to determine its long-term effectiveness for hips.

This is a comparative study between Synvisc and Kenalog (r), a commonly used injectable steroid. There is no placebo in this trial.

"The fact that very few patients have dropped out of the study suggests that the treatment is effective." Bockow said.

Patients participating in the Synvisc trial need to have osteoarthritis of the hip, and not have had an injection into the hip in the last six months.

Bockow said patients who qualify will receive two injections into the affected hip two weeks apart. The injections under fluoroscopy are done in the Highline Medical Center imaging department.

"Normally the cost of this procedure and the drug is approximately $2,000, but it is all free to participants in the study," he noted.

The costs of physician visits, x-rays and travel expenses are also covered through the study.

If a candidate for hip-replacement surgery is not ready for that procedure "and wants to buy some time, this might be a reasonable alternative," Bockow added.

Lyrica(tm), which was approved by the FDA last year for pain associated with diabetic peripheral neuropathy, also may help persons with chronic fibromyalgia.

Bockow said a controlled preliminary study of 529 patients with fibromyalgia "produced significantly greater reductions in pain [for those taking Lyrica] compared with placebo as well as improving sleep quality and fatigue."

This expanded trial lasts for six months. There is no placebo in this study for the first six months.

Arthritis Northwest is one of two or three clinics in the three-state region participating in this study. It is the only clinic in the Northwest participating in the Synvisc and voltaren trials.

For more information about these clinical trials, Arthritis Northwest can be reached at 206-246-7880.

Ralph Nichols can be reached at newsdesk@robinsonnews.com or 444-4873.