Osteoarthritis (OA):Updates on development, treatment and
possible prevention
Kevin Deane, MD/PhDAssociate Professor of Medicine
Division of RheumatologyUniversity of Colorado School of Medicine
July 13, 2014
Outline
Advances in understanding OA development
Advances in OA treatments
Possible Prevention
Images courtesy AAOS
PAIN LOSS OF FUNCTIO
N
Why does OA develop?
‘Old’ theory = injury to cartilage
‘New’ theory = injury to cartilage
BUT! Greater understanding of how the immune system interacts to drive progression of OA
Early days
But understanding how inflammation relates to OA should lead to treatments and prevention
Cartilage is prime component of the joint
Genetic issue = cartilage problem = easy to damage = OA
If a component of that damage is inflammation that could be blocked – could lead to treatment or
prevention
WARNING: LONG WAY TO GO!
Breakdown of cartilage is different that tissues that require cartilage for development
OA Treatments
Mainstays
1) Pain medications (acetaminophen, opiates)2) Anti-inflammatory medications (ibuprofen,
naproxen)3) Steroid injections4) Physical therapy5) Surgery – total joint replacement
Newer Treatments
1) Viscosupplementation (injections)
2) Glucosamine chondroitin sulfate
3) Surgical cartilage repair
4) Partial joint replacements and resurfacing
Is prevention of OA possible?
What is ‘prevention’?
Identification and stopping of a disease at an early time point before major problems develop Primary:Stop disease before it stopsExamples: vaccines, removal of standing water
Secondary:Find disease at a very early, treatable stageExamples: Breast and colon cancer
NO DISEASE
Risk factors may be present
EARLY DISEASE
May be without symptoms
FULL BLOWN DISEASE
Primary Prevention
Secondary Prevention
Keys for Prevention
Know what causes disease
Know who will get disease before they get it Tests, risks factors
Have a program to identify those who are at-risk
Have a treatment that works to prevent disease
Cost effective
Adapted from World Health Organization guidelines
OA Prevention
Certain risk factors are known - injury - mechanics - genetic conditions
Learning more about how to identify those at risk
Learning more about disease and finding targets for prevention
Recent Work Towards Prevention
MRI identifies subtle early findings of OA
Can be used to identify those at future risk while they are in a phase of disease that can be potentially modified
Sharma et al. Arthritis and Rheumatology 2014
Recent Work Towards Prevention
Injection of anti-inflammatory agent into joint after injury prevents future arthritis
A mechanism for prevention!
Mouse study!
Furman et al Arthritis Research and Therapy 2014
Questions