What is the role of peptides in treating shoulder osteoarthritis?

Peptides for Shoulder Osteoarthritis

Peptides are not recommended for treating shoulder osteoarthritis, as they are not mentioned in current clinical practice guidelines and lack evidence for efficacy in glenohumeral joint disease.

Current Guideline-Based Treatment Approach

The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guideline for glenohumeral osteoarthritis does not include peptide therapy among its 16 treatment recommendations 1. The evidence-based treatment algorithm follows this hierarchy:

First-Line Conservative Management

• Exercise-based physical therapy is the foundation of treatment, focusing on decreasing pain, increasing range of motion, and strengthening the rotator cuff 2
• No specific exercise prescription has proven superior, so recommendations should focus on patient preference including walking, cycling, resistance training, or neuromuscular training 2

Injectable Options (When Physical Therapy Insufficient)

• Injectable corticosteroids have insufficient evidence to recommend for or against their use (Grade I recommendation), though widely used in clinical practice 2
• Viscosupplementation (hyaluronic acid) is an option (Grade C recommendation), administered as three weekly injections with improvements in pain and function at 1,3, and 6 months 2, 3

Surgical Intervention (When Conservative Treatment Fails)

• Total shoulder arthroplasty (TSA) is preferred over hemiarthroplasty (Grade B recommendation, Level II evidence) for patients with glenohumeral OA 2
• TSA provides superior pain relief and global health assessment scores, with 14% of hemiarthroplasty patients requiring revision to TSA 2

Why Peptides Are Not Recommended for Shoulder OA

Lack of Shoulder-Specific Evidence

The available peptide research focuses exclusively on knee and hip osteoarthritis, not shoulder joints:

• BMP7-derived peptides showed promise in attenuating OA chondrocyte phenotype in laboratory studies and rat meniscal tear models, but this was not tested in shoulder joints 4
• Collagen peptides demonstrated efficacy in knee OA clinical trials but have no published data for glenohumeral application 5
• Collagen-binding peptides for enhanced imaging and drug delivery were studied only in knee joints of rats and minipigs 6
• Hyaluronic acid-binding peptide-polymer systems reduced OA progression in mouse knee models but lack shoulder joint validation 7

Critical Distinction from Established Treatments

While viscosupplementation (hyaluronic acid injections) is an established option for shoulder OA 2, 3, this refers to the full hyaluronic acid molecule, not peptide derivatives or peptide-conjugated systems that remain experimental.

Common Pitfalls to Avoid

• Do not extrapolate knee and hip OA peptide research to shoulder joints, as the biomechanics, loading patterns, and disease progression differ significantly between weight-bearing and non-weight-bearing joints 2
• Do not offer unproven peptide therapies when evidence-based options (physical therapy, viscosupplementation, arthroplasty) exist with established safety profiles 1
• Do not delay appropriate surgical referral in patients with failed conservative management, as TSA outcomes are superior when performed before severe joint destruction occurs 2

When to Refer for Surgery

Proceed to surgical consultation when:

• Conservative treatment (physical therapy, injections) fails to provide adequate pain relief or functional improvement 3
• Patient is appropriate age (concern exists for patients under 50 years due to prosthetic loosening risk) 3
• Refer to surgeons performing at least 2 shoulder arthroplasties per year to reduce complication rates 2, 3