OA Phenotype and Therapy
The application of modern imaging modalities has led to ground-breaking advances in understanding of the OA phenotype. Increasingly the OA literature demonstrates a shift toward personalised, pathology-targeted interventions. Imaging detected inflammation offers one potential target, for steroids (including oral agents) and rheumatoid arthritis anti-synovial therapies. Although studies targeting IL-1 have been disappointing, TNF inhibitor studies have shown more mixed results. MRI-identified BMLs are related to both pain and structural progression of knee OA. A number of pharmacological therapies with potential to positively affect trabecular structure have recently demonstrated benefits in large OA trials, including calcitonin, strontium and zoledronic acid. These exciting though relatively early attempts at phenotype-targeted therapies provide the basis for strong growth in this field.