Osteoarthritis 2014 Year in Review: Clinical
Gillian A. Hawker
Objective and Methods: To provide highlights of research over the past year related to the clinical epidemiology and treatment of osteoarthritis (OA), a systematic literature review was conducted using PubMed for the period between April 1, 2013 and March 31, 2014 using the search terms osteoarthritis, clinical epidemiology, treatment, and surgery. English language papers were reviewed and selected for inclusion based on study quality, relevance, and audience interest.
Results: Selected articles could be broadly grouped under three themes: 1. metabolic syndrome and OA; 2. determinants of non-response to hip and knee joint replacement; and 3. new and targeted OA therapies. Theme 1: Increasing evidence that chronic systemic inflammation in patients with metabolic syndrome may contribute to the incidence or progression of OA prompted a flurry of studies examining the cross-sectional and longitudinal relationships between metabolic factors (e.g., diabetes, BMI, and atherosclerosis) and OA and the impact of OA on CVD events and all-cause death. The results from these studies indicate that people with OA are at increased risk for CVD events. These findings have prompted additional research to elucidate potential mechanisms, including the effects of NSAID use, chronic inflammation, muscle weakness, and reduced mobility / physical activity due to OA. Studies in the past year have also confirmed a high prevalence of non-participation in OA self-management activities, including exercise, among people with OA due to pain, fear of falling, difficulty getting to self-management programs, depressed mood, and competing health issues. This is concerning since physical activity, together with diet, have been convincing linked to reduced systemic inflammation and improved joint pain and functioning. Theme 2: In light of rapidly increasing rates of hip and knee joint replacement for OA, and the documented variability in patient outcomes following this surgery, health services research has been increasingly focused on identification of modifiable determinants of “non-response”, e.g. the effects of pain sensitization, and development of prognostic tools which may inform patient-physician decision making about surgery. Theme 3: While there remains no highly effective non-surgical therapy for OA, the past year saw interesting developments with respect to novel OA pain therapies, including tanezumab, methotrexate, and duloxetine. The need for clinical trials in OA that better reflect patients’ needs (i.e, longer duration of treatment given that OA is a chronic disease and inclusion of subjects with other common chronic conditions given they are so common) were highlighted by several authors.
Conclusion: Clinical and health services research in OA is increasingly taking a more holistic view of the person with OA, recognizing that OA is a chronic disease which is highly co-prevalent with other common obesity- and age-related conditions. This perspective is necessary to address the prevention and treatment of OA going forward. OA treatment strategies that target combinations of clustered conditions are likely to be more effective.