Personalizing the management of knee osteoarthritis

Abstract

Knee osteoarthritis (OA) is common, debilitating, and heterogeneous in clinical presentation, making a personalized approach essential. In 2020, an estimated 595 million people globally (7% of the population) live with OA with the knee being affected in ~50% of cases^1,2. From 1990 to 2020, OA ranked as the 14^th highest cause of age-adjusted years lived with disability². In addition to considerable economic impact¹, knee OA profoundly affects quality of life, through functional impairment and pain³. Clinically, knee osteoarthritis presents as pain, particularly with weight bearing, and stiffness in the morning or with prolonged sitting that improves within 30 minutes⁴. Randomized clinical trials have shown that multiple treatments are efficacious, including physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), duloxetine, joint injections, and joint replacement⁴. However, there is considerable heterogeneity in clinical presentation, impact, and course of knee OA^5-9. Moreover, the current “trial-and-error” management of knee OA focuses primarily on joint pathology, neglecting amplifying pain processing in the nervous system and psychosocial mechanisms. Personalizing treatment selection by identifying relevant mechanisms in each patient and incorporating treatments that address these mechanisms holds promise for improvement of knee OA management.