Osteoarthritis, are we still running late?

Osteoarthritis is a leading cause of permanent physical disability, and the trends of an ageing population and increasing obesity are likely to compound. Osteoarthritis affects more than 1.5 billion people worldwide, with women disproportionately affected by the condition. The number of people affected globally rose by 48% from 1990 to 2019. From an economic perspective, each year in the United States alone, $140 billion are spent as a direct consequence of osteoarthritis cost. At the same time, an additional $140 billion are lost annually due to induced job absenteeism because of Osteoarthritis. These data are concerning but probably underestimate the true size of the problem. Additionally, social determinants, the built environment, and access to health care all impact the disparate disease burden and cost of osteoarthritis, particularly in lower-income and middle-income countries.

Despite its considerable personal, economic, and societal toll, osteoarthritis is generally neglected. The condition does not feature in global strategic plans for non-communicable diseases. Yet, Osteoarthritis commonly coexists with heart disease, diabetes, and mental health problems and can worsen the morbidity and mortality associated with these conditions. Patients with osteoarthritis also report health practitioners to downplay their concerns. Therapeutic nihilism may affect patients and practitioners, with misperceptions that Osteoarthritis is an inevitable part of ageing and that there are no effective treatments. Current healthcare approaches can swing from neglect of core treatments, such as exercise, weight loss, and education, to expensive and disability inducing invasive therapies for late-stage disease like total or partial knee replacement.

In recent years, myriad regenerative and tissue preservation options have expanded the treatment alternatives available to practitioners. This increase in research and development of new approaches has been fostered by advances in biotechnological techniques like gene therapy, cell therapy, disease-modifying drugs and other regenerative medicine technologies. The common factor of these new approaches is the possibility to trigger earlier intervention protocols which may lead to delayed or less accelerated Osteoarthritis symptoms. In addition, new joint preservation treatments have been reported to be less expensive than later-stage disease treatment and surgical procedures.

Finally, there have been tremendous advances, including in our understanding of the impact and burden of osteoarthritis globally, the pathogenesis of the condition, the identification of those at risk of disease progression and technologies to treat the pathology. Opportunities for progress now lie in applying public health interventions to screen and identify disease before significant symptoms set in to enable practitioners to trigger preventive treatment, which can delay the progression of the pathology. In this context, novel approaches will be crucial to improve osteoarthritis prevention and management.