The OA problem can be considered at 2 levels:
Firstly, in terms of the burden the disease poses to the patient and the society, in terms of disability, work loss and cost of treatment. This is comprehensively laid out in OARSI’s white paper to the FDA.
Secondly, in terms of how we currently conceptualise OA as a disease: its pathogenesis and how best to impose the now de rigueur “Treat-to-Target” framework in its management.
Regarding the second, I posit that OA should be thought of as a problem of Repair & Regeneration not keeping pace with Inflammation & Damage, resulting ultimately in clinically relevant Pain & Disability.
It follows then that, as a clinical priority and fundamental target of treatment, pain should first be adequately addressed in order to return the patient to a functional state. Thereafter, modifiable underlying causes and perpetrating pathogenic mechanisms of inflammation and regenerative deficit are the loftier but secondary tier goals. These goals are no longer far-fetched, as the coming days’ posts will show.