Pharmacolocal treatments for osteoarthritis

Introduction 

Osteoarthritis (OA) is the most prevalent musculoskeletal disease worldwide, affecting over 300 million people in 2017. It is characterized by progressive degeneration of the articular joint, affecting mainly the hands, hips and knees. OA has a great impact on the patient’s quality of life that could lead to chronic pain and disability, but also has a considerable economic burden. Knowledge on the pathophysiology of OA is still evolving, from being viewed as a cartilage-limited disease to a multifactorial disease that affects the whole joint. Several factors have been reported to contribute to its clinical presentations, some of which are genetics, gender, joint mechanics, overweight, inflammation and age. Recent studies have highlighted the presence of multiple OA subgroups. Disease progression in OA is usually slow; however, some patients manifest rapid disease progression leading to the precocious need for total joint replacement. Identification of OA phenotypes has also been made according to the number of affected joints, biomechanical factors, genome-wide expression analysis and the presence of lesions in the subchondral bone. Moreover, profiles of patients can be defined according to their level of pain, functional disability and presence of comorbidities. Despite its multifactorial origin, the pathological changes of the disease have common features that affect all joint structures, such as degradation of the articular cartilage, osteophyte formation, subchondral bone changes and synovial inflammation.