Clinical overview of osteoarthritis (OA) and the challenges faced for future management

This article provides a clinical overview of osteoarthritis (OA) and the challenges faced in its future management. It highlights significant developments in the understanding of OA etiology and pathogenesis which have occurred over the course of the 20th century. OA is a highly prevalent, painful, disabling, and costly condition. Until recently, cartilage degeneration was considered the initial pathologic defect. However, it is now recognized that OA is a whole-joint disease, involving many other joint structures including subchondral bone, ligaments, menisci, muscles, peripheral nerves, and synovium. Furthermore, pain originates from multiple domains-peripheral, psychological, and neurological. This makes OA a challenging disease to treat and there remains no disease-modifying OA drugs (DMOADs) available to slow disease progression. Efforts are underway globally to identify new drug targets, improve the management of OA in clinical practice and prevent the increase in OA prevalence into the future which are summarized in the article.