1. Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology University of Colorado School of Medicine July 13, 2014

2. Outline Advances in understanding OA development Advances in OA treatments Possible Prevention

3. Images courtesy AAOS

4. PAIN LOSS OF FUNCTION PAIN LOSS OF FUNCTION

5. Why does OA develop? ‘Old’ theory = injury to cartilage ‘New’ theory = injury to cartilage BUT! Greater understanding of how the immune system interacts to drive progression of OA

6. Early days But understanding how inflammation relates to OA should lead to treatments and prevention

7. Cartilage is prime component of the joint Genetic issue = cartilage problem = easy to damage = OA If a component of that damage is inflammation that could be blocked – could lead to treatment or prevention WARNING: LONG WAY TO GO! Breakdown of cartilage is different that tissues that require cartilage for development

8. OA Treatments

9. Mainstays 1)Pain medications (acetaminophen, opiates) 2)Anti-inflammatory medications (ibuprofen, naproxen) 3)Steroid injections 4)Physical therapy 5)Surgery – total joint replacement

10. Newer Treatments 1)Viscosupplementation (injections) 2)Glucosamine chondroitin sulfate 3)Surgical cartilage repair 4)Partial joint replacements and resurfacing

11. Is prevention of OA possible?

12. What is ‘prevention’? Identification and stopping of a disease at an early time point before major problems develop Primary: Stop disease before it stops Examples: vaccines, removal of standing water Secondary: Find disease at a very early, treatable stage Examples: Breast and colon cancer

13. NO DISEASE Risk factors may be present NO DISEASE Risk factors may be present EARLY DISEASE May be without symptoms EARLY DISEASE May be without symptoms FULL BLOWN DISEASE Primary Prevention Secondary Prevention

14. Keys for Prevention Know what causes disease Know who will get disease before they get it Tests, risks factors Have a program to identify those who are at-risk Have a treatment that works to prevent disease Cost effective Adapted from World Health Organization guidelines

15. OA Prevention Certain risk factors are known - injury - mechanics - genetic conditions Learning more about how to identify those at risk Learning more about disease and finding targets for prevention

16. Recent Work Towards Prevention MRI identifies subtle early findings of OA Can be used to identify those at future risk while they are in a phase of disease that can be potentially modified Sharma et al. Arthritis and Rheumatology 2014

17. Recent Work Towards Prevention Injection of anti-inflammatory agent into joint after injury prevents future arthritis A mechanism for prevention! Mouse study! Furman et al Arthritis Research and Therapy 2014

18. Questions