Joint tissue damage prior development of radiographic osteoarthritis

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Knee OA can no longer be viewed as a disorder of hyaline cartilage only. We could show that OA may start as a result of pathology to other joint tissues than cartilage and will or will not affect other joint tissues in the course of the disease. In fact, other processes appear to be more influential than cartilage damage, including the presence of inflammation and structural damage to the meniscus as well as subchondral bone. The number of tissues affected by pathology further increases the risk of developing OA. We can conjecture that there are a number of alternate pathways leading to OA. The failure of clinical trials to demonstrate treatment efficacy of OA drugs to date may be due, in part, to the failure of understanding OA as multi-tissue disease beginning at disease onset, given that eligibility is commonly based on radiography-based eligibility criteria and end points. The use of MRI can help investigators select subjects who are most suitable for a specific aim of the trial, taking into account disease phenotypes and potential treatment targets. MRI seems to be the modality of choice on which to define imaging based criteria for inclusion in and end points of OA trials.

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