Could an Epilepsy Drug Change Osteoarthritis Treatment? Beyond Painkillers

Osteoarthritis can turn everyday activities such as walking, climbing stairs and getting up from a chair into painful tasks. While existing treatments help manage symptoms, they do not reliably restore cartilage that has already been lost.

Now, researchers at Yale University are exploring whether lacosamide, an existing epilepsy drug, could help tackle both pain and cartilage degeneration. In preclinical studies, the drug showed encouraging results, while a collagen-based hydrogel was developed to retain it within the joint and release it gradually. Could a drug designed for another condition offer a new direction for arthritis treatment? Hyderabad orthopaedic specialists assess the science behind the possibility.

BEYOND WEAR AND TEAR

Osteoarthritis is not merely a consequence of ageing but a complex disease influenced by previous injuries, obesity, joint deformities and metabolic health. “It affects the entire joint, including cartilage, bone and surrounding tissues, and is much more than simple wear and tear,” says Dr K J Reddy, Chief Joint Replacement Surgeon.

Ageing reduces cartilage’s ability to repair itself, while inflammation can speed up tissue breakdown. Excess weight places stress on joints and may contribute to inflammation. Diabetes and other metabolic conditions affect joint health.

Could targeting these underlying processes change treatment? “Absolutely,” says Dr Reddy. Researchers are exploring therapies targeting inflammation, cartilage degeneration and the biological processes driving joint damage. However, he cautions that no treatment has yet been proven to reliably regenerate lost cartilage or reverse advanced osteoarthritis.

TWO PROBLEMS, ONE POTENTIAL APPROACH

The Yale study takes a different route by investigating Nav1.7, a sodium channel involved in pain signalling that may also affect cartilage-cell activity.

“Lacosamide may help address two major problems in osteoarthritis: pain and cartilage damage,” says Dr G Veda Prakash, Senior Consultant Orthopaedic and Joint Replacement Surgeon.

The researchers reported promising results in laboratory experiments and animal models, including increased cartilage-building activity and reduced degeneration. The collagen II-based hydrogel is designed to retain the drug in the joint for longer. However, the findings do not establish its effectiveness in humans. Clinical trials must assess its safety, optimal dosage, efficacy and long-term benefits.

Can cartilage grow back?

Protecting existing cartilage from further deterioration is not the same as rebuilding tissue that has already been lost.

The Yale team reported promising preclinical findings, but the results cannot yet establish cartilage regeneration in people.

“However, we cannot yet say that it can regrow lost cartilage in humans. This needs to be established through clinical trials,” Dr Veda Prakash cautions.

Researchers must also establish whether the benefits last and whether the treatment improves pain, mobility and quality of life beyond existing therapies.

COULD KNEE REPLACEMENT BE DELAYED?

If future trials show meaningful benefits, the treatment could help some patients preserve joint function for longer. However, it is too early to say whether it could delay surgery. “Osteoarthritis affects more than cartilage. It also involves the subchondral bone, meniscus, ligaments and synovial membrane. Degenerative changes in these structures may not be prevented by this discovery,” explains Dr Veda Prakash.

WHAT PATIENTS SHOULD DO?

Dr Reddy emphasises that exercise, weight management and control of metabolic conditions remain central to osteoarthritis care. Physiotherapy can improve muscle strength, mobility and function. “Patients should be cautious about treatments promising to regenerate cartilage or reverse arthritis,” he says. He recommends checking the scientific evidence, potential risks, expected benefits and costs before proceeding with regenerative therapies or supplements.

As Dr Reddy explains, “Pain relief does not necessarily mean that the disease has stopped progressing.” Researchers must assess symptoms, joint function and structural changes over time to establish whether a treatment genuinely slows disease progression.

An anti-seizure drug’s new promise

Dr. R. A. Purnachandra Tejaswi

Lacosamide shows promise as a potential treatment for both pain and cartilage degeneration in osteoarthritis. A 2026 study in Bioactive Materials found that it reduced cartilage breakdown in laboratory experiments and cartilage degeneration and pain-related behaviours in mice.

“Researchers also developed a collagen-based hydrogel to deliver the drug directly into the joint and prolong its effects. However, these findings remain experimental. Human clinical trials are needed to establish its safety, efficacy and long-term benefits. Lacosamide is not yet an established treatment for osteoarthritis.”

WHY THE HYDROGEL MATTERS

Conventional oral medicines circulate through the body. An injectable, sustained-release system aims to deliver a drug locally and retain it within the joint for longer.

Osteoarthritis is much more than wear and tear. It is a complex disease affecting the entire joint. Pain relief does not necessarily mean that the disease has stopped progressing.”

— DR K J REDDY

The most catchy finding is that lacosamide may help address two major problems in osteoarthritis: pain and cartilage damage. However, we cannot yet say that it can regrow lost cartilage in humans.”

— DR G VEDA PRAKASH