Osteoarthritis (OA) is the most common type of arthritis worldwide and rapidly increasing with ageing European populations. This degenerative process is a major source of pain and disability for individuals and economic burden for health economies. There are a range of treatment options for OA, using non-pharmacological and pharmacological approaches; these are well documented in a range of recent, authoritative, evidence-based guidelines. However current symptomatic treatments are often limited by compliance, side effects or poor efficacy and many people with OA live with chronic pain. Modern imaging, in particular MRI, has helped us to understand that OA is a dynamic remodelling process involving all the structures within the joint. Inflammation is common in OA, with a high prevalence of synovitis seen on imaging, and this has been associated with joint pain. MRI detected changes within the subchondral bone are also common and associated with pain and structural progression; targeting such individual pathologies may offer potential new therapeutic options for OA. Trials of traditional rheumatoid arthritis therapies that treat synovitis are underway. Monoclonal antibodies against nerve growth factor and centrally acting drugs have recently undergone trials in OA. Whilst treatment for OA has until now relied on symptom management, for the first time, recent trials suggest that structure modification may be possible by treating the subchondral bone. Much work is still required to optimize use of current therapies and develop new treatments for OA.
Disclosure of Interest P. Conaghan Consultant for: Janssen, Merck, Pfizer, Servier