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