November 10-15

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ACR Convergence 2023

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Defining different phenotypes may provide new OA treatment pathways


2 minutes

A Tuesday ACR/ARHP combined session, Phenotyping Hip & Knee OA: Toward Better Clinical Care & Patient Outcomes, will explore emerging science on osteoarthritis phenotypes and how further understanding of the different phenotypes might improve clinical care for osteoarthritis patients.

Ali Mobasheri, PhD
Ali Mobasheri, PhD

Ali Mobasheri, PhD, Professor of Musculoskeletal Physiology in the School of Veterinary Medicine at the University of Surrey in the U.K., will discuss the underlying mechanisms involved in common osteoarthritis (OA) phenotypes during the 90-minute session that starts at 2:30 pm in Room 11 B.

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

In fact, he said, several ongoing investigations are conducting sophisticated analyses of observational studies and clinical trial datasets to understand better the phenotypes responsible for why people develop OA and why, prognostically, they have differences in terms of rapidity of progression.

David Hunter, MBBS, PhD, FRACP
David Hunter, MBBS, PhD, FRACP

Also during this session, David Hunter, MBBS, PhD, FRACP, Florance and Cope Chair of Rheumatology and Chair of the Institute of Bone and Joint Research at the University of Sydney in Australia, will provide an overview of how osteoarthritis phenotypes might inform prognosis and response to treatment.

“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,” Dr. Hunter said. “What we’re learning, however, is underneath all of that, there are likely five to ten 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.”

He said a patient diagnosed with osteoarthritis that involves a meniscal tear, for example, would have a different prognosis and would respond to different treatment than a patient who has an altered bone shape or has extensive synovial inflammation.

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