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How smearing fat on your joints can ease arthritis
By Jerome Burne
PUBLISHED: 01:17, 4 February 2014 | UPDATED: 01:17, 4 February 2014
Arthritis affects around nine million people in the UK and is a major cause of pain and disability.
A radical new treatment for arthritis has just appeared on local pharmacy shelves - a gel that contains no medication.
It is smeared, not rubbed, on to the skin, where it apparently slides through the pores and into the painful joint, where it begins to replace the natural lubrication lost through the disease.
It takes around a week to provide relief - about the time it takes you to use up a single tube on one joint.
The gel, Flexiseq, contains tiny spheres made of the same sort of fat, called phospholipid, that lubricates joints and allows them to move freely. It's the fat, and not any drug, that brings the benefit.
The design of the spheres has implications beyond this one treatment and could mark a new way of carrying drugs into the body, reducing the need for injections.
Arthritis affects around nine million people in the UK and is a major cause of pain and disability. It's caused by wear and tear on the joints, specifically the cartilage. It also leads to the synovial fluid, a jelly-like substance which is secreted by the membrane that surrounds the joint, becoming thin and less elastic.
'The lubrication in it is provided by the same type of fat that Flexiseq is made from,' says Dr Liam O'Toole, of the charity Arthritis Research UK.
'The gel could be particularly useful for patients on blood-thinning drugs such as warfarin who are advised not to take standard treatments such as non‑steroidal anti-inflammatory painkillers.'
Any new treatment for arthritis is to be welcomed, according to Dr John Dickson, a GP from Yorkshire and founder of the Primary Care Rheumatology Society, which educates GPs about arthritis and encourages research.
'NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin and Celebrex - often used for arthritis - come with a nasty range of potential side-effects, including severe internal bleeding, and they don't tackle the underlying problem,' says Dr Dickson, who suffers from arthritis in his hands.
A review of trials involving 4,000 people, by Professor Philip Conaghan, of the Leeds Institute of Rheumatic and Musculoskeletal Medicine, published last year, reported that Flexiseq was as effective as Celebrex capsules in reducing pain and improving movement.
The only side-effect some people reported was mild inflammation where the gel had been applied.
Now, scientists are trying to use the technology behind this new gel to help develop treatments for other conditions.
Flexiseq is the first over-the-counter product to make use of nanotechnology. It uses tiny balls of fat known as liposomes. These are so small they don't even show up under powerful microscopes.
In Flexiseq, the liposomes are made of phospholipids, the fat also found in joints.
In future, this type of liposome could transport the likes of insulin and some cancer drugs right through the skin, cutting out the need for injections.
Packaging a toxic drug in a liposome means you need less of it because it can be delivered directly to the cells you want to treat, such as a tumour or the liver.
This is done by adding a protein marker to the liposome's surface, so only those particular protein cells in the tumour or liver, say, would absorb them.
The liposomes in Flexiseq are able to pass through the pores of the skin but don't end up in the bloodstream because they are too big to get into the tiny blood vessels just below the surface. However, they can enter the membrane surrounding the joint, which has bigger pores.
Already, two new liposome-drug combinations targeting skin conditions are in the pipeline.
'The skin is a very effective barrier, which is why getting medicines and cosmetics through it has always been a challenge,' says Professor Jayne Lawrence, of the Royal Pharmaceutical Society.
'I think these new flexible liposomes will soon be carrying in drugs for inflammation and skin infections, but it will be a while before we see them delivering drugs for the likes of diabetes or cancer.'
Being able to deliver lubricants directly into joints through the skin raises the possibility that it might be possible to slow down or even stop arthritis from getting worse.
Ken Brooks, a 49-year-old osteopath in Leeds, was one of the first people in Britain, along with some of his patients, to try Flexiseq.
Ken has had serious problems with knee and hip joints since a motorcycle crash as a teenager.
'I don't like regular painkillers because of the damage they can do long term,' he says. 'But I've tried pretty much everything else - including surgery to wash out some loose bits of cartilage and injections into joints. Flexiseq is not a miracle cure, but it certainly has improved my flexibility.'
The treatment needs to be applied twice daily and is best left to dry, as the outside of each liposome is naturally attracted to water (all liposomes have one side that 'loves' fat and one that 'loves' water). Once the water in the gel has evaporated, the liposomes will naturally start moving towards the water that's beneath the skin and so on into the joints.
Then you should start gently exercising the joint, as this action pumps the liposomes onto the cartilage.
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