Osteoarthritis Phenotypes May Lead to Better Treatment Options

Observing different osteoarthritis (OA) phenotypes may help physicians determine the optimal treatment for patients, according to a session presented at the American College of Rheumatology/Association of Rheumatology Health Professionals

Annual Meeting.

“For decades, we viewed osteoarthritis as a homogeneous wear-and-tear disease—a view that has been challenged recently. It is now clear that osteoarthritis is a heterogeneous disease and has multiple etiologies and phenotypes,” said speaker Ali Mobasheri, PhD.

Physicians may be able to harness the numerous phenotypes associated with OA to guide treatment strategy.

“Each of these different phenotypes may be targeted differently, opening up multiple pathways for therapeutic intervention,” Dr Mobasheri said. “Combining imaging and carefully selected panels of biochemical markers can achieve enhanced patient stratification and lead to better-designed clinical trials.”

The speakers said there are multiple ongoing studies that are analyzing datasets to form a better understanding regarding phenotypes that lead to OA. These studies are also uncovering why there are differences in progression based on phenotypes, according to the session.

During the session, the speakers also highlighted how OA phenotypes may inform prognosis and treatment response.

“Currently, when a doctor sees a patient who has knee or hip pain, for example, they’ll diagnose them with osteoarthritis based on a diagnostic classification that is quite old—essentially the constellation of pain, patient age, and some physical findings,” said speaker David Hunter, MBBS, PhD, FRACP. “What we’re learning, however, is underneath all of that, there are likely 5 to 10 different etiologic classifications as to why that person developed osteoarthritis and probably a similar number of phenotypes as to why they might have an altered prognosis.”

For example, the speakers said that OA related to a meniscal tear would have a vastly different prognosis than a patient who has an altered bone shape, according to the session. These patients would also respond to treatments differently.

“The lumping of osteoarthritis into one umbrella term does not serve us well when it comes to understanding why the disease develops, why some people seem to progress more rapidly than others, and how we can best distinguish different treatment subgroups that may be more responsive to particular interventions,” Dr Hunter said.

Basing treatment on a patient’s phenotype will help physicians prescribe a more targeted therapy, which may result in a better outcome, according to the panel.

“The treatment paradigms we currently use are limited to relieving pain and not focused on ameliorating the disease,” Dr Hunter concluded. “Only through an improved understanding will we be able to truly define the phenotypes of osteoarthritis and develop specific treatments for phenotypic subgroups.”