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Herrero-Beaumont G, Roman-Blas JA, Bruyère O, Cooper C, Kanis J, Maggi S, Rizzoli R, Reginster JY. Clinical settings in knee osteoarthritis: Pathophysiology guides treatment. Maturitas 2016; 96:54-57. [PMID: 28041596 DOI: 10.1016/j.maturitas.2016.11.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/14/2016] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA) is the most common chronic joint disorder and its prevalence increases rapidly during midlife. Complex interactions of genetic alterations, sex hormone deficit, and aging with mechanical factors and systemic inflammation-associated metabolic syndrome lead to joint damage. Thus, the expression of a clinical phenotype in the early stages of OA relies on the main underlying pathway and predominant joint tissue involved at a given time. Moreover, OA often coexists with other morbidities in the same patient, which in turn condition the OA process. In this scenario, an appropriate identification of clinical phenotypes, especially in the early stages of the disease, may optimize the design of individualized treatments in OA. An ESCEO-EUGMS (European Union Geriatric Medicine Society) working group has recently suggested possible patient profiles in OA. Hereby, we propose the existence of 4 clinical phenotypes - biomechanical, osteoporotic, metabolic and inflammatory - whose characterization would help to properly stratify patients with OA in clinical trials or studies. Further research in this field is warranted.
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Affiliation(s)
- Gabriel Herrero-Beaumont
- Joint and Bone Research Unit, Rheumatology Department, Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain.
| | - Jorge A Roman-Blas
- Joint and Bone Research Unit, Rheumatology Department, Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Olivier Bruyère
- Support Unit in Epidemiology and Biostatistics, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NHIR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - John Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Abstract
INTRODUCTION Conventional medical therapies for osteoarthritis are mainly palliative in nature, aiming to control pain and symptoms. Traditional intra-articular therapies are not recommended in guidelines as first line therapy, but are potential alternatives, when conventional therapies have failed. AREAS COVERED Current and future intra-articular drug therapies for osteoarthritis are highlighted, including corticosteroids, hyaluronate, and more controversial treatments marketed commercially, namely platelet rich plasma and mesenchymal cell therapy. Intraarticular disease modifying osteoarthritis drugs are the future of osteoarthritis treatments, aiming at structural modification and altering the disease progression. Interleukin-1β inhibitor, bone morphogenic protein-7, fibroblast growth factor 18, bradykinin B2 receptor antagonist, human serum albumin, and gene therapy are discussed in this review. The evolution of drug development in osteoarthritis is limited by the ability to demonstrate effect. High quality trials are required to justify the use of existing intra-articular therapies and to advocate for newer, promising therapies. EXPERT OPINION Challenges in osteoarthritis therapy research are fundamentally related to the complexity of the pathological mechanisms of osteoarthritis. Novel drugs offer hope in a disease with limited medical therapy options. Whether these future intra-articular therapies will provide clinically meaningful benefits, remains unknown.
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Affiliation(s)
- Shirley P Yu
- a Department of Rheumatology , Royal North Shore Hospital , Sydney , Australia
| | - David J Hunter
- b Institute of Bone and Joint Research , Kolling Institute, University of Sydney , Sydney , Australia
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Roman-Blas JA, Bizzi E, Largo R, Migliore A, Herrero-Beaumont G. An update on the up and coming therapies to treat osteoarthritis, a multifaceted disease. Expert Opin Pharmacother 2016; 17:1745-56. [DOI: 10.1080/14656566.2016.1201070] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Jorge A. Roman-Blas
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Emanuele Bizzi
- UOS of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Raquel Largo
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
| | - Alberto Migliore
- UOS of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, Service of Rheumatology, IIS-Fundación Jiménez Díaz, Autonomous University of Madrid, Madrid, Spain
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Migliore A, Bizzi E, De Lucia O, Delle Sedie A, Tropea S, Bentivegna M, Mahmoud A, Foti C. Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:117-31. [PMID: 27279754 PMCID: PMC4898442 DOI: 10.4137/cmamd.s39143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. METHODS An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. RESULTS Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. CONCLUSIONS There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient.
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Affiliation(s)
- A Migliore
- Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - E Bizzi
- Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - O De Lucia
- Division and Chair of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | | | - S Tropea
- Rete Reumatologica, ASP 7 RG, Ragusa, Italy
| | - M Bentivegna
- Rete Reumatologica Coordinator, ASP 7 RG, Ragusa, Italy
| | - A Mahmoud
- Physical Medicine, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt.; Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - C Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
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Oxidative stress, autophagy, epigenetic changes and regulation by miRNAs as potential therapeutic targets in osteoarthritis. Biochem Pharmacol 2016; 108:1-10. [DOI: 10.1016/j.bcp.2015.12.012] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/14/2015] [Indexed: 02/07/2023]
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Bruyère O, Cooper C, Arden N, Branco J, Brandi ML, Herrero-Beaumont G, Berenbaum F, Dennison E, Devogelaer JP, Hochberg M, Kanis J, Laslop A, McAlindon T, Reiter S, Richette P, Rizzoli R, Reginster JY. Can we identify patients with high risk of osteoarthritis progression who will respond to treatment? A focus on epidemiology and phenotype of osteoarthritis. Drugs Aging 2016; 32:179-87. [PMID: 25701074 PMCID: PMC4366553 DOI: 10.1007/s40266-015-0243-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis co-morbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis.
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Affiliation(s)
- Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart-Tilman B23, 4000, Liège, Belgium,
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Mendel OI, Luchihina LV, Mendel W. Aging and osteoarthritis. Chronic nonspecific inflammation as a link between aging and osteoarthritis (a review). ADVANCES IN GERONTOLOGY 2015. [DOI: 10.1134/s2079057015040165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Kraus VB, Blanco FJ, Englund M, Karsdal MA, Lohmander LS. Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use. Osteoarthritis Cartilage 2015; 23:1233-41. [PMID: 25865392 PMCID: PMC4516635 DOI: 10.1016/j.joca.2015.03.036] [Citation(s) in RCA: 356] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 03/18/2015] [Accepted: 03/31/2015] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a heterogeneous disorder. The goals of this review are (1) To stimulate use of standardized nomenclature for OA that could serve as building blocks for describing OA and defining OA phenotypes, in short to provide unifying disease concepts for a heterogeneous disorder; and (2) To stimulate establishment of ROAD (Risk of OA Development) and ROAP (Risk of OA Progression) tools analogous to the FRAX™ instrument for predicting risk of fracture in osteoporosis; and (3) To stimulate formulation of tools for identifying disease in its early preradiographic and/or molecular stages - REDI (Reliable Early Disease Identification). Consensus around more sensitive and specific diagnostic criteria for OA could spur development of disease modifying therapies for this entity that has proved so recalcitrant to date. We fully acknowledge that as we move forward, we expect to develop more sophisticated definitions, terminology and tools.
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Affiliation(s)
- V B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - F J Blanco
- Grupo de Proteomica, ProteoRed/ISCIII, Servicio de Reumatologia, Instituto de Investigación Biomedica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias, 15006, A Coruña, Spain
| | - M Englund
- Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston University, MA, USA
| | | | - L S Lohmander
- Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Research Unit for Musculoskeletal Function and Physiotherapy, and Department of Orthopedics and Traumatology, University of Southern Denmark, Odense, Denmark
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Gait Characteristics, Symptoms, and Function in Persons With Hip Osteoarthritis: A Longitudinal Study With 6 to 7 Years of Follow-up. J Orthop Sports Phys Ther 2015; 45:539-49. [PMID: 25996360 DOI: 10.2519/jospt.2015.5441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Longitudinal laboratory study. OBJECTIVES (1) To compare gait characteristics between individuals with early-stage hip osteoarthritis who underwent total hip replacement (THR) and those who did not undergo THR, and (2) to evaluate whether gait characteristics, function, and symptoms declined among individuals who did not undergo THR during a 6- to 7-year follow-up. BACKGROUND The natural history of symptoms, function, and gait changes secondary to hip osteoarthritis, including potential differences at an early stage of disease, is unknown. METHODS Forty-three individuals (mean age, 58.9 years) with radiographic and symptomatic hip osteoarthritis participated. Outcome measures included 3-D gait analysis; self-reported pain, stiffness, and function; hip range of motion; and the six-minute walk test. Baseline comparisons between individuals who later underwent THR and those who did not undergo THR were made using independent t tests or Mann-Whitney U tests. Comparisons of baseline measures and 6- to 7-year follow-up for the nonoperated individuals were conducted with paired-samples t tests or Wilcoxon signed-rank tests (P<.05). RESULTS Twelve (27.9%) of the 43 individuals initially evaluated had not undergone THR at the 6- to 7-year follow-up. At baseline, these individuals had larger sagittal plane hip and knee joint excursions, larger joint space width, lower body mass index, and superior self-reported function compared with the individuals who later underwent THR. At the 6- to 7-year follow-up, the individuals who did not undergo THR exhibited no decline in gait characteristics, minimum joint space, or overall function. Furthermore, their self-reported pain had significantly decreased (P = .024). CONCLUSION Individuals who did not undergo THR during a 6- to 7-year follow-up period did not exhibit a decline in gait, function, or symptoms compared to those who underwent THR. These findings are suggestive of a phenotype of hip osteoarthritis with a very slow disease progression, particularly in regard to pain. LEVEL OF EVIDENCE Prognosis, level 1b.
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Ruiz-Romero C, Blanco FJ. What steps are needed to achieve perfect diagnostic and monitoring tests for osteoarthritis? ACTA ACUST UNITED AC 2015. [DOI: 10.2217/ijr.15.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zhang W, Likhodii S, Zhang Y, Aref-Eshghi E, Harper PE, Randell E, Green R, Martin G, Furey A, Sun G, Rahman P, Zhai G. Classification of osteoarthritis phenotypes by metabolomics analysis. BMJ Open 2014; 4:e006286. [PMID: 25410606 PMCID: PMC4244434 DOI: 10.1136/bmjopen-2014-006286] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To identify metabolic markers that can classify patients with osteoarthritis (OA) into subgroups. DESIGN A case-only study design was utilised. PARTICIPANTS Patients were recruited from those who underwent total knee or hip replacement surgery due to primary OA between November 2011 and December 2013 in St. Clare's Mercy Hospital and Health Science Centre General Hospital in St. John's, capital of Newfoundland and Labrador (NL), Canada. 38 men and 42 women were included in the study. The mean age was 65.2±8.7 years. OUTCOME MEASURES Synovial fluid samples were collected at the time of their joint surgeries. Metabolic profiling was performed on the synovial fluid samples by the targeted metabolomics approach, and various analytic methods were utilised to identify metabolic markers for classifying subgroups of patients with OA. Potential confounders such as age, sex, body mass index (BMI) and comorbidities were considered in the analysis. RESULTS Two distinct patient groups, A and B, were clearly identified in the 80 patients with OA. Patients in group A had a significantly higher concentration on 37 of 39 acylcarnitines, but the free carnitine was significantly lower in their synovial fluids than in those of patients in group B. The latter group was further subdivided into two subgroups, that is, B1 and B2. The corresponding metabolites that contributed to the grouping were 86 metabolites including 75 glycerophospholipids (6 lysophosphatidylcholines, 69 phosphatidylcholines), 9 sphingolipids, 1 biogenic amine and 1 acylcarnitine. The grouping was not associated with any known confounders including age, sex, BMI and comorbidities. The possible biological processes involved in these clusters are carnitine, lipid and collagen metabolism, respectively. CONCLUSIONS The study demonstrated that OA consists of metabolically distinct subgroups. Identification of these distinct subgroups will help to unravel the pathogenesis and develop targeted therapies for OA.
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Affiliation(s)
- Weidong Zhang
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Sergei Likhodii
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Yuhua Zhang
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Erfan Aref-Eshghi
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Patricia E Harper
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Edward Randell
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Roger Green
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Glynn Martin
- Department of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Andrew Furey
- Department of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Guang Sun
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Proton Rahman
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Guangju Zhai
- Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
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