Most recent developments in strategies to reduce the progression of structural changes in osteoarthritis: today and tomorrow

Osteoarthritis (OA) is the most common of the musculoskeletal diseases. Within the context of the ageing population, it is rapidly becoming a significant medical and financial burden to the world. Knowledge of its clinical manifestations and effect on quality of life has helped the medical community to appreciate the real impact of the disease on the health of a steadily increasing number of patients. In response to the need for better medical treatments for OA, several therapeutic strategies have been developed. It is expected that new therapies currently in development will prevent the progression of this debilitating disease. Although significant progress has recently been made in the treatment of a number of arthritic diseases, including rheumatoid arthritis (RA), many difficulties encountered in OA research have hindered the development of effective treatments. The disease develops and changes slowly, and clinically represents a heterogeneous group of disorders that are often referred to as osteoarthritic diseases. The absence of objective and definitive biochemical markers has also been a major hurdle for clinical and therapeutic research.The development of disease-modifying osteoarthritis drugs (DMOADs) is a rather complex process. A number of obstacles remain including regulatory issues, length of clinical trials, the lack of validation and consensus on new biological markers, and the fact that recent developments in more effective imaging technology are not yet commonly used. Moreover, the duration of treatment is likely to be life long. Most of the DMOADs that have been brought into development thus far have failed because of their safety profile or lack of efficacy. In this regard, one might wonder whether some negative findings of trials might be accounted for by the lack of suitable technology to assess and quantify disease progression reliably. Fortunately, studies completed and underway are providing information that may soon allow us to overcome thes