The role of imaging in disentangling the enigma of osteoarthritis

Excerpt

Osteoarthritis (OA) is one of the most prevalent diseases, with a global disease burden estimated at nearly 528 million affected persons in 2019 [1]. Imaging has played a critical role in OA research for the past several decades. The advent of computed tomography (CT) and magnetic resonance imaging (MRI) has helped our understanding of the interaction between different tissues in the osteoarthritic joint, with the bulk of research focused on the knee joint. Largely thanks to the application of MRI to large clinical studies, it is now accepted consensus to perceive OA as a “whole-organ” disorder involving multiple joint tissues, eventually leading to joint failure. Nonetheless, despite major advances in OA imaging research, much remains to be done. To date, no disease-modifying OA drug (DMOAD) has been approved by the regulatory agencies. This is also a result of the reliance on radiography as the main modality to be used in DMOAD trials. Radiographic joint space narrowing (JSN) is currently recommended by both the Federal Drug Administration (FDA) and European Medicines Agency (EMA) guidance documents as the imaging endpoint for DMOAD trials. However, radiographic changes occur late in the disease, are restricted to the assessment of bony features of OA, and do not correlate well with the patient’s symptoms [2]. Alternative imaging modalities and methodologies for the evaluation of structure in a clinical trial context to be used for eligibility screening and as outcome measures have been suggested [3]. …