Wk.10 L4 - Treatment and management of osteoarthritis

Question 1

LO

Answer 1

1. Explain how OA treatment is approached in terms of structural disease versus symptoms
2. Recall current therapies and their efficacy
3. Outline the development and biological rationale of future therapeutics
   (ie build on knowledge gained from lecture 1)

Question 2

OA: risk factors and mechanisms

Answer 2

Biologically active disease process where the cells in the different joint tissues respond to external signals
- Mechanical (excess loading, instability)
- Biological (inflammation, adipokines, aging)

Defining the activated pathological pathways and how they change with time will identify targets to modify OA initiation and progression

Question 3

OA modifiable risk factors

Answer 3

2 key modifyable key factors:
- Obesity/ metabolic syndrome
- Joint injury

Both can lead to activation of onset

Question 4

OA pathology vs pain

Answer 4

Structural pathology:
- Multi-tissue

Pain Vs Disability & physical function:
- NOT the same and not well correlated
- NOT well correlated with structure
- Different types of pain (nociceptive, nociplastic, neuropathic)

Question 5

OA treatment

Answer 5

NO approved structural disease modifying drugs for OA
- slow progression
- halt progression
- reverse pathology

Key targets are symptoms and risk-factor modification:
- pain
- disability
- physical function
- QOL

Question 6

Biological targeted therapies

Answer 6

No consensus & NO strong (RCT) evidence supporting
- targeting inflammatory cytokines
- targeting bone remodelling
- stem cells
- cell-derived exosomes
- etc.

Question 7

Surgical therapies

Answer 7

Joint injury (OA prevention)
- no change in OA risk with ACL repair
- increased OA risk with meniscectomy

Existing OA
- arthroscopy – not recommended
- joint alignment (high tibial osteotomy)
- arthroplasty (joint replacement)

Question 8

Where are we failing?

Answer 8

From the begining of the patients journey
Over 50% of patients pain and functional status is not well assessed

Many patients referred incorrect treatments

Question 9

Current OA treatment

Answer 9

OA Management
- adequate pain control still unmet need
- mismatch between guidelines and clinical practice

Need to re-engineer health service delivery
for chronic disease management

Question 10

Improving OA treatment

Answer 10

May need:
- multi-tissue approach
- pathology & pain therapies
- phenotype-targeted therapies
- Biomarkers to identify endotype

Can identify problems through phenotypes and endotypes with biomarkers
- Allowing fot individualised and more effective treatment