Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD...

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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

Transcript of Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD...

Page 1: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

Osteoarthritis (OA):Updates on development, treatment and

possible prevention

Kevin Deane, MD/PhDAssociate Professor of Medicine

Division of RheumatologyUniversity of Colorado School of Medicine

July 13, 2014

Page 2: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

Outline

Advances in understanding OA development

Advances in OA treatments

Possible Prevention

Page 3: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

Images courtesy AAOS

Page 4: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

PAIN LOSS OF FUNCTIO

N

Page 5: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

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

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Early days

But understanding how inflammation relates to OA should lead to treatments and prevention

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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

Page 8: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

OA Treatments

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Mainstays

1) Pain medications (acetaminophen, opiates)2) Anti-inflammatory medications (ibuprofen,

naproxen)3) Steroid injections4) Physical therapy5) Surgery – total joint replacement

Page 10: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

Newer Treatments

1) Viscosupplementation (injections)

2) Glucosamine chondroitin sulfate

3) Surgical cartilage repair

4) Partial joint replacements and resurfacing

Page 11: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

Is prevention of OA possible?

Page 12: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

What is ‘prevention’?

Identification and stopping of a disease at an early time point before major problems develop Primary:Stop disease before it stopsExamples: vaccines, removal of standing water

Secondary:Find disease at a very early, treatable stageExamples: Breast and colon cancer

Page 13: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

NO DISEASE

Risk factors may be present

EARLY DISEASE

May be without symptoms

FULL BLOWN DISEASE

Primary Prevention

Secondary Prevention

Page 14: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

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

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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

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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

Page 17: Osteoarthritis (OA): Updates on development, treatment and possible prevention Kevin Deane, MD/PhD Associate Professor of Medicine Division of Rheumatology.

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

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Questions