Can we identify a 'high risk' patient profile to determine who will experience rapid progression of osteoarthritis?

Disease modifying drugs for osteoarthritis (OA) that may halt or retard joint destruction and at the same time possibly improve symptoms are being developed and tested at various stages in clinical trials. This has, for at least two reasons, focused attention on the need for identification of patient groups at high risk for incident or progressive OA. First, well characterized such groups may be useful in clinical trials. Second, assuming that disease modifying OA drugs become available in the future, primary target groups in need of such therapy have to be identified. Risk factors for incident OA may differ from those for OA progression. Interactions between risk factors for OA is little understood. Factors that have consistently been reported as associated with radiographic OA progression are obesity, generalized OA, alignment and synovitis. Other factors such as bone scintigraphic lesions, joint injury nad biomarkers (such as type II collagen fragments, COMP and HA) show promise. Further evaluation of these variables and their individual and combined influence will be useful to design a risk profile for OA incidence and progression.