innovation to improve care

Osteoarthritis, which affects nearly 600 million people worldwide, remains one of the most common pathologies of aging, with a slightly higher incidence in women, according to WHO. In France, about 7 million people are infected. This disease affects the cartilage of joints, most often the knees or hips, causing chronic pain and significant difficulty walking. In fact, it has become one of the leading causes of sedentary lifestyle among older adults and, in turn, contributes to all the serious complications that this lifestyle entails: increased cardiovascular risk, hypertension, diabetes, etc.

In the absence of treatment for osteoarthritis, treatment is aimed at relieving pain and maintaining mobility to slow the progression of the disease and minimize the impact on quality of life. But for this it is necessary to intervene in evolution as early as possible. However, to date, diagnosis remains very late. American study published in Science achievements gives hope for very early identification of people at risk. From the blood samples, the researchers identified a number of biomarkers that predict knee osteoarthritis eight years before the onset of symptoms.

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The role of pro-inflammatory proteins

The team compared serum samples taken at different times in life from 200 British women, half of whom had been diagnosed with knee osteoarthritis. These analyzes took into account patients’ body mass index (BMI) and age, two known risk factors for osteoarthritis. After testing the samples, the scientists found that 6 blood proteins were found at significantly higher levels in the serum of the affected women. Their dosage made it possible to predict the disease in 77% of cases 8 years before the onset of the first symptoms.

Overall, most of these proteins are involved in inflammation of the knee joint, more specifically at the level of the synovial membrane lining the inside of the joint. Typically, the function of the synovium is to lubricate the joint and therefore essentially plays a mechanical role. “Chronic inflammation of this membrane can accelerate cartilage degeneration, increase pain and reduce joint mobility, which contributes to the development of osteoarthritis. But this is just a hypothesis, since until now there has been no consensus on the inflammatory origin of this disease. That’s why this study is interesting.”– emphasizes Francis Berenbaum, head of the department of rheumatology at the Saint-Antoine Hospital in Paris.

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Towards better care

This discovery opens up new perspectives in the treatment of this disease. “This means that we could, using a simple blood test, predict who is at risk and therefore implement preventive strategies to reduce the occurrence and progression of the disease.”, explains Yves Hanrotin, president of the Osteoarthritis Foundation and professor at the University of Liège. There is currently no cure for osteoarthritis. Its treatment involves relieving painful symptoms by taking painkillers or anti-inflammatory drugs. In case of intolerance to these medications, doctors may resort to injections of cortisone, hyaluronic acid, or even installation of prostheses. However, these options have mixed effectiveness, and 20% of patients continue to experience pain on a daily basis.

This is why finding ways to screen at-risk subjects poses a major challenge in the prevention of this pathology. This will address preventable risk factors for osteoarthritis: excess weight, in particular, helps accelerate the breakdown of cartilage, putting pressure on joints. “If we can predict that an obese person is at high risk of developing knee osteoarthritis, this will double the argument for urgent treatment of this excess weight.”, explains Dr. Berenbaum. Likewise, knowing that one in two people who suffer a knee injury will develop osteoarthritis within 10 years, identifying those at high risk will allow targeted therapeutic interventions, such as physical therapy.

However, this study has some limitations. “77% is a good discriminatory value, but it still leaves a high probability of diagnostic error for about 1 in 4 patients.”, emphasizes Professor Hanrotin. Another problem: The markers the scientists identified are likely not specific to osteoarthritis. “In addition to articular cartilage, these compounds are found in other tissues that do not play a role in osteoarthritis, especially connective tissue, increasing the risk of diagnostic errors.”, warns the professor. Therefore, further studies are needed to refine these prediction parameters, which also need to be studied in larger cohorts, including women and men, before considering their possible routine use.