Osteoarthritis

Osteoarthritis (OA) is the most common form of joint disease, and its impact is set to grow as the prevalence of obesity rises and our elderly population increases. Many clinicians regard OA as simply a disease of 'wear and tear', and by implication one in which disease modification is not possible. Such prejudices have led to significant academic apathy in this disease, reflected not only in our poor understanding of disease pathogenesis, but also in the failure to classify the disease with greater precision, and to develop sensitive tools for diagnosis and prognostic assessment. The identification of key degradative enzymes in cartilage and the use of mouse models to study disease pathogenesis have greatly changed our outlook in recent years. Evidence-based management of the condition is outlined in international guidelines: education, weight control/loss and exercise (general, joint-specific) are core interventions. Analgesia and non-pharmacological and surgical approaches that favourably affect joint biomechanics are used for treating painful OA unresponsive to core interventions; there are no disease-modifying OA drugs. Ultimately, this disease remains the most common reason for total joint replacement. The next decade is likely to see significant advances in our understanding, and treatment, of this condition.