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1Rheumatology Department, Monash Health, Melbourne, Australia.
Abstract:
Osteoarthritis (OA) affects more than 240 million people worldwide. In 2016, the Osteoarthritis Research Society International submitted a report to the United States Food and Drug Administration highlighting OA as a 'serious' disease, and appealed for the urgent development and review of new therapies to address a significant unmet need. Despite this, international guidelines for the treatment of OA have been largely unchanged for over a decade. There is now an updated understanding that OA is more than simply a non-inflammatory 'wear-and-tear' process involving articular cartilage. Based on this, potential emerging therapies are being developed that target novel inflammatory, pain, and regeneration pathways. Drugs targeting the latter are being lauded as 'Disease-Modifying Osteoarthritis Drugs' - a concept which has so far proved elusive in OA research. While this review does not recommend a change in current practice, it should prompt readers to rethink the OA treatment paradigm. The global pandemic has added another layer of consideration when managing patients with OA. At a time when there is more strain on hospital systems, there is a need to expand our pharmacological armamentarium in order to manage OA without elective surgery and hospital admission.
Insights
Osteoarthritis (OA) is a serious disease impacting millions globally. Emerging therapies target novel pathways, prompting a reevaluation of current OA treatment strategies beyond cartilage degeneration.
Area of Science:
- Rheumatology and Orthopedics
- Pharmacology
- Regenerative Medicine
Background:
- Osteoarthritis (OA) affects over 240 million people worldwide, recognized as a serious condition with significant unmet needs.
- Current international OA treatment guidelines have remained largely unchanged for over a decade.
- OA is now understood as more than just articular cartilage 'wear-and-tear', involving complex inflammatory and pain pathways.
Approach:
- Review of emerging therapeutic strategies targeting novel inflammatory, pain, and regeneration pathways in OA.
- Exploration of the concept of 'Disease-Modifying Osteoarthritis Drugs' (DMOADs) and the challenges in their development.
- Consideration of the impact of the global pandemic on OA management and the need for non-surgical treatment options.
Key Points:
- Emerging therapies aim to address OA through innovative approaches beyond traditional management.
- The development of DMOADs remains a critical, yet elusive, goal in OA research.
- The pandemic highlights the need for expanded pharmacological options to manage OA without hospitalization.
Conclusions:
- This review advocates for a paradigm shift in thinking about OA treatment, despite not recommending immediate changes to current practice.
- A broader pharmacological armamentarium is needed to manage OA effectively, especially in light of strained healthcare systems.
- Rethinking the OA treatment paradigm is crucial for addressing the disease comprehensively and adapting to global health challenges.
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