Satellite Luncheon Symposium: Regenerating Your Views on Hip and Knee OA: A State-of-the-Art Symposium

Knee OA: What’s on the Horizon?

Finding new therapies for osteoarthritis (OA) remains a huge unmet need for patients and clinicians. Trial failures have resulted in (slow) evolution of OA clinical trial design, a search for relevant phenotypes (recently with the use of AI) and new outcomes, and re-consideration of what might be designated a DMOAD. 

In terms of non-pharmacological therapies, new approaches include digital interventions and gene therapies. A range of conventional synthetic DMARD therapies have been trialled in OA, though only methotrexate with its multiple actions has demonstrated analgesic and functional benefits after 6 months of therapy in a recent large RCT of knee OA. Interestingly this study did not suggest methotrexate benefits on synovitis. Biologic DMARDs have not been successful: studies investigating anti-TNF therapies had generally poor results. Although previous anti-interleukin-1 clinical trials have not demonstrated analgesic or structural benefits, a post-hoc analysis from a large long-term cardiovascular study demonstrated a large reduction in total joint replacement in the active treatment arms. Further understanding of the drivers of OA pain is needed, with new therapeutics targeting nociceptive pathways. And what about weight loss as an OA therapy? 

Speakers

• Philip Conaghan

Hip Osteoarthritis Essentials

Hip osteoarthritis is a prevalent source of pain, functional limitation, and cost. Important risk factors for hip osteoarthritis include obesity, genetics, family history, joint injury, and morphological abnormalities (e.g. dysplasia, cam and pincer deformities), among others. Key nonoperative therapies include exercises and physical therapy, and analgesia (typically with NSAID’s). Total hip replacement has generally excellent outcomes. The appropriate indications for periacetabular osteotomy (for dysplasia) and arthroscopy with labral tear repair and osteoplasty for cam, and pincer deformities are areas of continued investigation.  

Speakers

• Jeffrey Katz

What’s new in OA Imaging in Clinical Trials?

Despite decades of research efforts and multiple clinical trials aimed at discovering efficacious disease-modifying osteoarthritis (OA) drugs (DMOAD), we still do not have a drug that shows convincing scientific evidence to be approved as an effective DMOAD. It has been suggested these DMOAD clinical trials were in part unsuccessful since eligibility criteria and imaging-based outcome evaluation were solely based on conventional radiography. The OA research community has been aware of the limitations of conventional radiography being used as a primary imaging modality for eligibility and efficacy assessment in DMOAD trials. An imaging modality for DMOAD trials should be able to depict soft tissue and osseous pathologies that are relevant to OA disease progression and clinical manifestations of OA. Magnetic resonance imaging (MRI) fulfills these criteria and advances in technology and increasing knowledge regarding imaging outcomes likely should play a more prominent role in DMOAD clinical trials. In my presentation, I will describe MRI-based tools and analytic methods that can be applied to DMOAD clinical trials with a particular emphasis on knee OA. MRI should be the modality of choice for eligibility screening and outcome assessment. Optimal MRI pulse sequences must be chosen to visualize specific features of OA.

Speakers

• Ali Guermazi 

Past, Present, and Future of Cartilage Restoration: From Localized Defect to Arthritis

OA, one of the most common joint diseases, is characterized by the loss of joint function due to articular cartilage destruction. Herein, we review current and previous research involving the clinical applications of arthritis therapy and suggest potential therapeutic options for OA in the future. The arthroscopic cartilage regeneration procedure or realignment osteotomy has been performed as a joint-conserving procedure in cases where conservative treatment for damaged articular cartilage and early OA failed. If cartilage regeneration is ineffective or if the joint damage progresses, arthroplasty is the main treatment option. The need for biological arthritis treatment has expanded as the healthy lifespan of the global population has increased. Accordingly, minimally invasive surgical treatment has been developed for the treatment of damaged cartilage and early OA. However, patients generally prefer to avoid all types of surgery, including minimally invasive surgery. Therefore, in the future, the treatment of OA will likely involve injection or medication. Currently, arthritis management primarily involves the surgical application of therapeutic agents to the joints. However, nonsurgical or prophylactic methods are expected to become mainstream arthritis therapies in the future.

Speakers

• Seok-Jung Kim