Osteoarthritis: From Palliation to Prevention AOA Critical Issues
Osteoarthritis: From Palliation to Prevention AOA Critical Issues
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DOI：
10.2106/jbjs.m.01209
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发表时间：
2014-08-06
影响因子：
5.3
通讯作者：
Olson, Steven A.
中科院分区：
文献类型：
--
作者：
Chu, Constance R.;Millis, Michael B.;Olson, Steven A.
骨性关节炎是导致残疾的主要原因。传统上对晚期骨关节炎的关注并没有产生有效的疾病修正治疗方法。因此，目前的临床护理主要集中在姑息治疗，直到关节置换指征。研讨会的形式被用来研究支持骨关节炎的临床方法从缓解到预防的转变的新策略。这一讨论的中心是诊断和治疗骨关节炎前期的概念，这意味着关节状况会增加骨关节炎加速发展的风险。三种常见的骨科疾病--前交叉韧带撕裂、关节内骨折和髋关节发育不良--的翻译和临床研究报告被用来说明这些观点。介绍了采用超短回声时间增强T2*(UTE-T2*)图形式的新型定量磁共振成像(MRI)在机械健全的环境中评估关节软骨修复表层下损伤的潜力的新信息。这些数据表明，改进的诊断方法既可以识别处于危险中的软骨，也可以评估早期治疗策略的有效性。通过使用一种新的关节内骨折小鼠模型，研究表明炎症与骨折严重程度相关，超级治愈的小鼠避免了早期创伤后骨关节炎，部分原因是增强了抑制炎症的能力。这些发现表明，急性和持续的抗炎治疗在预防骨性关节炎方面具有作用。对于长期治疗，现代基因治疗方法可能为关节内持续注射抗炎药物和其他生物活性物质以恢复关节内平衡提供一种有效的手段。为了说明早期治疗预防或延缓致残性骨关节炎发病的潜力，关节软骨的积极临床效果以及髋关节结构异常手术矫正后的长期临床随访突出了靶向机械因素在延缓骨关节炎发病中的作用。鉴于骨科医生治疗各种关节问题，从关节创伤到骨关节炎前期和终末期骨关节炎，认识到范式向预防骨关节炎的转变对于促进改善临床护理和参与涉及新治疗策略的临床研究至关重要。
Osteoarthritis is a leading cause of disability. The traditional focus on late-stage osteoarthritis has not yielded effective disease-modifying treatments. Consequently, current clinical care focuses on palliation until joint replacement is indicated. A symposium format was used to examine emerging strategies that support the transformation of the clinical approach to osteoarthritis from palliation to prevention. Central to this discussion are concepts for diagnosis and treatment of pre-osteoarthritis, meaning joint conditions that increase the risk of accelerated development of osteoarthritis. The presentation of translational and clinical research on three common orthopaedic conditions-anterior cruciate ligament tear, intra-articular fracture, and hip dysplasia-were used to illustrate these ideas. New information regarding the use of novel quantitative magnetic resonance imaging (MRI) in the form of ultrashort echo time enhanced T2* (UTE-T2*) mapping to evaluate the potential for articular cartilage to heal subsurface damage in a mechanically sound environment was presented. These data indicate that improved diagnostics can both identify cartilage at risk and evaluate the effectiveness of early treatment strategies. With use of a new mouse model for intra-articular fracture, it was shown that inflammation correlated to fracture severity and that super-healer mice avoided early posttraumatic osteoarthritis in part through an enhanced ability to dampen inflammation. These findings suggest that there is a role for acute and sustained anti-inflammatory treatment in the prevention of osteoarthritis. For long-term treatment, contemporary gene-therapy approaches may offer an effective means for sustained intra-articular delivery of anti-inflammatory and other bioactive agents to restore joint homeostasis. To illustrate the potential of early treatment to prevent or delay the onset of disabling osteoarthritis, the positive clinical effects on articular cartilage and in long-term clinical follow-up after operative correction of structural abnormalities about the hip highlight the role for targeting mechanical factors in delaying the onset of osteoarthritis. Given that orthopaedic surgeons treat the full spectrum of joint problems, ranging from joint trauma to pre-osteoarthritic conditions and end-stage osteoarthritis, an awareness of the paradigm shift toward the prevention of osteoarthritis is critical to the promotion of improved clinical care and participation in clinical research involving new treatment strategies.