Can We Identify Patients with High Risk of Osteoarthritis Progression Who Will Respond to Treatment? A Focus on Biomarkers and Frailty

Abstract

Osteoarthritis (OA), a disease affecting different patient phenotypes, appears as an optimal candidate for personalized healthcare. The aim of the discussions of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group was to explore the value of markers of different sources in defining different phenotypes of patients with OA. The ESCEO organized a series of meetings to explore the possibility of identifying patients who would most benefit from treatment for OA, on the basis of recent data and expert opinion. In the first meeting, patient phenotypes were identified according to the number of affected joints, biomechanical factors, and the presence of lesions in the subchondral bone. In the second meeting, summarized in the present article, the working group explored other markers involved in OA. Profiles of patients may be defined according to their level of pain, functional limitation, and presence of coexistent chronic conditions including frailty status. A considerable amount of data suggests that magnetic resonance imaging may also assist in delineating different phenotypes of patients with OA. Among multiple biochemical biomarkers identified, none is sufficiently validated and recognized to identify patients who should be treated. Considerable efforts are also being made to identify genetic and epigenetic factors involved in OA, but results are still limited. The many potential biomarkers that could be used as potential stratifiers are promising, but more research is needed to characterize and qualify the existing biomarkers and to identify new candidates.

Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis

“…This study has implications for research in OA and exercise science, and responds to the call for further research to identify psychological factors that predict response in OA 4,8,9,50,51 . Identifying factors that influence treatment response may enhance stratified-randomization strategies that attempt to balance comparator groups of exercise trials to reduce confounding 8,52 .…”

“…Current clinical guidelines emphasize rehabilitative exercise treatment as the foundation of conservative symptom management 3 . However, the manifestations of knee OA and response to treatment varies 4–7 . This heterogeneity of clinical presentation and treatment response confounds interpretation of therapeutic clinical trials and complicates the care decisions for clinicians 4,5 .…”

“…However, the manifestations of knee OA and response to treatment varies 4–7 . This heterogeneity of clinical presentation and treatment response confounds interpretation of therapeutic clinical trials and complicates the care decisions for clinicians 4,5 . Thus, identifying clinical factors to define patient profiles most likely to benefit from treatment would help therapeutic decision-making 6,8 .…”

Chondroprotective effects of the combination chondroitin sulfate-glucosamine in a model of osteoarthritis induced by anterior cruciate ligament transection in ovariectomised rats

“…Biochemical biomarkers are an important research area in OA that will support new drug developments, preventive medicine, and medical diagnostics for OA [23]. Early changes in joint and bone during OA may be followed by determinations of biomarkers [24].…”

Therapeutic application of mesenchymal stem cells in osteoarthritis

“…Profiles of patients have to be drawn based on OA subtypes classified according to the joint involved, the age and body mass index (BMI), the level of pain, the grade of the disease, the functional limitation, a history of traumas, the genetic susceptibility, and the presence of relevant biomarkers. An attempt for such classification is being discussed by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group [92]. Such a classification of OA subtypes would also benefit for other therapeutic approaches.…”