Is osteoarthritis a heterogeneous disease that can be stratified into subsets?

Abstract

Osteoarthritis is a heterogeneous disease characterized by variable clinical features, biochemical/genetic characteristics, and responses to treatments. To optimize palliative effects of current treatments and develop efficacious disease-modifying interventions, treatments may need to be tailored to the individual or a subset of osteoarthritic joints. The purpose of this review is to explore the current literature on the clinical and physiological variability in osteoarthritis and potential for stratifying patients. Several stratifications have been reported, including mechanism of onset, stage of disease progression, involved joints, inflammatory levels, and effusion. Most of these methods revealed two to three unique subsets of osteoarthritis. Osteoarthritic joints may be stratified by an array of variables, some transient and others consistent throughout the disease process. Future research needs to continue to explore stratification techniques since these may be the key to optimizing palliative interventions and developing disease-modifying interventions for subsets within this heterogeneous disease.

The Potential of Multiple Synovial-Fluid Protein-Concentration Analyses in the Assessment of Knee Osteoarthritis

“…Subsets of OA should not be clinically accepted, however, until they are defined by unique biochemical (or genetic) markers and therapeutic responses (or outcomes). 38 It is highly likely that future research will use proteomic techniques (eg, multiplex ELISA) to assess biochemical differences between therapeutic responders and nonresponders. Data from these studies may indicate protein concentrations that identify therapeutic responders and enable clinicians to use baseline biochemical markers to optimize treatments.…”

“…38 In this model a unique patient–pathology interaction defines the pathologic joint within a continuous disease model rather than a discrete classification (eg, OA vs no OA or effused vs noneffused). Patient– pathology interactions may be characterized by subsets or variables that remain constant throughout the progression of disease (eg, mechanism of onset) or fluctuate across time (eg, progression rate, effusion, disease stage, symptom severity).…”

Risk Factors of Symptomatic Knee, Hand and Hip Osteoarthritis in a Suburban Area of İzmir City

“…According to the World Health Organization (WHO), osteoarthritis causes disability for approximately 10% of people who are 60 years old or over around the globe (4). In 2007, the United Nations announced that the world population would increase by 2.5 billion until 2050 (5,6).…”

Phénotypes cliniques : arthroses plutôt qu’arthrose. Comorbidités

“…Le traitement de l'arthrose n'est pas univoque, et tous les patients ne répondent pas de la même façon à un traitement donné [6]. Cette notion est importante aussi bien pour le thérapeute au lit du patient que lors de l'élaboration d'un protocole d'essai clinique où l'absence de sélection d'un sous-groupe d'arthrose potentiellement répondeur va compromettre la mise en évidence d'un effet thérapeutique.…”