Therapeutic targets for osteoarthritis

Osteoarthritis (OA) is a multi-factorial disease, which, as the population ages, puts an ever increasing burden on health care resources. The treatment of OA, in terms of disease modifying drugs, has lagged well behind that of the inflammatory arthritides, and it may be that research in this area has been misguided. It is unlikely that a single therapy will be effective in what is a very heterogeneous condition. There is evidence that OA should be thought of as a disease of the whole musculoskeletal system, affecting not only cartilage, but also muscle, ligaments, bone and even adipose tissue. In developing novel therapies, greater attention needs to be given to the mechanics of the joint environment. Whilst, as yet, there is no disease modifying therapy available for the treatment of OA, many of the existing, more conservative therapies have been shown to be effective. In particular, the management of obesity is important both for the prevention and progression of the disease. Other interventions, such as exercise therapy and viscosupplementation also have their place. However, patient compliance with these therapies is often less than optimal and looking for ways of improving this may be an area for future research.