4 insights on Osteoarthritis from EULAR 2024 congress

Long-term Effectiveness of Lifestyle Interventions¹

Dr. Carlijn Wagenaar presented the “Plants for Joints” (PFJ) randomized clinical trial², which demonstrated significant improvements in patients with hip and knee OA and metabolic syndrome. The two-year follow-up study confirmed that the reductions in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores observed at 4 months were sustained over time, underscoring the long-term benefits of lifestyle interventions in managing OA.

Exploring the Gut-Joint Axis³

Dr. Daniele Mauro’s presentation on the microbiome’s role in OA highlighted the concept of microbiota dysbiosis and its correlation with gut inflammation and OA^4-12.

The study suggested that inflammation from the gut could reach the joints through mucosal immune cells and microbiota produced proinflammatory factors, contributing to OA^7,10,13-15. Furthermore, Mauro brought attention to the fact that dysbiosis of the genital tract mucosa has also been shown to impact on arthritis¹⁶. Restoring intestinal permeability showed promise in animal models, potentially preventing and reducing arthritis severity^5,8,17.

These findings underscore the emerging role of the gut-joint axis in the pathogenesis of OA and other rheumatic diseases.

Updated Non-Pharmacological Management Recommendations¹⁸

Professor Nina Osteras provided updated EULAR recommendations for the non-pharmacological management of hip and knee OA¹⁹.

Key recommendations included education and advice on self-management strategies, personalized exercise programs, healthy weight education, and behavioural change techniques, and the use of assistive devices and workplace adaptations.

The guidelines emphasized the importance of education and advice on self-management strategies as well as individualized care plans to enhance patient participation and reduce pain.

Identifying Pathogenic Endotypes in OA²⁰

Professor Tonia Vincent discussed findings from the STEP-uP OA²¹ consortium, which analysed synovial fluid from OA patients to identify molecular endotypes.

The study revealed that a significant portion of the variance in samples was driven by intracellular protein score (IPS), and identified two indistinct endotypes present in the discovery, replication and combination datasets which were driven by the IPS. These endotypes were not observed when IPS was regressed. Proteome analysis pointed to a single pathogenic pathway characterized by the epithelial-mesenchymal transition. Identification of patient specific phenotypic characteristics may slightly differentiate them and may open approaches for personalized medicine.

Conclusion

The EULAR 2024 congress underscored the importance of a holistic approach to OA research and management, integrating lifestyle interventions, and cutting-edge scientific discoveries. These insights highlight the potential for personalized medicine and underscore the need for continued multidisciplinary research to improve patient outcomes in OA.

Bibliography

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