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Low-cost, widely used diabetes medication may soon revolutionize the way we treat knee osteoarthritis (OA). Monash University researchers have discovered that metformin, a medication commonly prescribed for type 2 diabetes, can alleviate knee pain in individuals with a higher weight or obese individuals, and potentially even prevent the need for expensive knee replacement surgery.
Results published in JAMA may hold significant implications for how physicians treat this painful joint disease.
Research holds hope for pain management in OA patients.
The six-month double-blind trial involved 107 adults, all of whom were diabetes-free, with symptomatic knee OA. Participants were given either metformin (maximum dose 2000 mg daily) or a placebo, both tracked through telehealth.
“These results support the use of metformin for the treatment of symptomatic knee osteoarthritis in people with overweight or obesity,” the researchers found. “Because of the modest sample size, confirmation in a larger clinical trial is warranted.”
By trial end:
Metformin takers reported a decrease in knee pain of 31.3 points (on a scale of 0-100).
Placebo takers reported a decrease of 18.9 points.
This modest but significant improvement indicates that metformin can be a promising solution for OA pain relief, particularly where other interventions have not worked.
Why a Low-Cost Drug Could Disrupt Expensive Surgery Trends
Lead researcher and head of rheumatology for Alfred and Monash Universities, Professor Flavia Cicuttini, said too many patients with early-stage OA are choosing knee replacement surgery too early.
“At first glance, this may seem reasonable, but it is a major problem because patient dissatisfaction with knee replacements is already high at between 20-30 per cent, even when the operation is technically perfect*. Dissatisfaction rates are highest when the operation is done for early knee OA. This costs about 3.5 times as much, so about $70,000 compared to $20,000, and the results tend not to be as good as the first time. The best outcome for patients is to delay the knee replacements until it is absolutely needed.” Professor Cicuttini said
Holding off on surgery until absolutely essential can result in improved outcomes and less health care burden.
A Familiar Drug, A Fresh Use
Metformin is already familiar to primary care physicians. It is cheap, safe, and used for diabetes and other conditions, including polycystic ovary syndrome.
In OA of the knee, it does the following:
Decreases low-grade inflammation
Improves metabolic function
Facilitates modest weight loss.
“Metformin works in a number of ways on the knee, including affecting low-grade inflammation and other metabolic pathways that are important in knee OA. It is a different way to treat knee OA pain. GPs are very familiar with metformin, which is a low-cost, safe medication. It could be provided to patients in addition to other treatments they use and has the potential to delay people having knee replacements before they are absolutely needed. If people on metformin have less knee pain and are able to do more physical activity, then knee replacements can wait.” Professor Cicuttini said
These multi-faceted effects, together with exercise and weight management, could make metformin a useful adjunct to OA management.
Increasing access with telehealth
The trial's success using telehealth also points to the possible availability of metformin, especially for individuals living in rural or disadvantaged areas.
“Metformin is safe and well tolerated. It is used safely in other non-diabetes conditions such as polycystic ovarian syndrome. Metformin could be provided simply and safely using a telehealth approach, as we did in our study, meaning that it could be provided across the community, including in regional and remote areas.” Professor Cicuttini said
Future prospects: Changes in OA treatment strategy?
No new OA medicines have been approved in Australia since the 1990s. This research opens the way for a promising new approach to treatment, one that could enhance quality of life and avoid premature surgery. While further large-scale trials are required, metformin's excellent safety profile and affordability make it an attractive option to consider now.
Reference:
Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial” by Feng Pan, Yuanyuan Wang, Yuan Z. Lim, Donna M. Urquhart, Mahnuma Mahfuz Estee, Anita E. Wluka, Rory Wolfe and Flavia M. Cicuttini, 24 April 2025, JAMA. DOI: 10.1001/jama.2025.3471
(Input from various sources)
(Rehash/Muhammad Faisal Arshad/MSM)
