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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Target-based approach for osteoarthritis treatment
Gustavo C de Campos, Antonio M Tieppo, Cyro S de Almeida Jr, Paulo C Hamdan, Wilson M Alves, Márcia U de Rezende
Gustavo C de Campos, Department of Orthopedics and Traumatology, Hospital de Clínicas da Universidade Estadual de Campinas, Campinas, SP 13083-887, Brazil
Antonio M Tieppo, Cyro S de Almeida Jr, Department of Physiatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP 01221-020, Brazil
Paulo C Hamdan, Departamento de Medicina Esportiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ 21941-901, Brazil
Wilson M Alves, Ortopedia, Pontifícia Universidade Católica de Campinas, Campinas, SP 13087-571, Brazil
Márcia U de Rezende, Instituto de Ortopedia e Traumatologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 05403-010, Brazil
Author contributions: de Campos GC conceived the idea, conducted a literature search, reviewed the relevant literature, contributed to the writing and illustration, and reviewed and approved the final version of the article; Tieppo AM, de Almeida Jr CS, and Hamdan PC reviewed the relevant literature, collaborated with the manuscript, and reviewed and approved the final version of the article; Alves WM contributed with the idea, reviewed the relevant literature, collaborated with the manuscript, and reviewed and approved the final version of the article; and de Rezende MU reviewed the relevant literature, collaborated with the manuscript, contributed to the discussion and with writing, and reviewed and approved the final version of the article.
Conflict-of-interest statement: The authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Gustavo C de Campos, MD, PhD, Surgeon, Department of Orthopedics and Traumatology, Hospital de Clínicas da Universidade Estadual de Campinas, R. Tessália Vieira de Camargo, 126, Cidade Universitária, Campinas 13083-887, SP, Brazil. gustavoccampos@usp.br
Received: April 8, 2020
Peer-review started: April 8, 2020
First decision: April 22, 2020
Revised: May 4, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: June 18, 2020
There is still no definitive treatment for knee osteoarthritis (OA). We are certainly far from a consensus on the best form of treatment or on an effective treatment recommendation. There are reasons for the current equivocal treatment recommendations in the face of this very serious health problem. The greatest of these reasons, undoubtedly, is the great complexity of the factors involved in the development and progression of knee OA and the complex pathophysiology including mechanical, inflammatory, metabolic, post-traumatic, molecular, genetic, and psychological changes. For several years, an attempt has been made to correlate different patient phenotypes to different patterns of response to treatment, thus creating the possibility of developing specific treatments for certain groups of patients and theoretically allowing better treatment efficacy. However, in practice we still find totally different responses and evolutions even in individuals belonging to the same phenotype. Thus, classification by phenotypes, despite being an advance, is not sufficient. The present article proposes a fragmented look at each of the many factors or targets involved in the genesis and evolution of OA. Therefore, we propose not the treatment of OA per se but the management of an individual set of targets to achieve personalized OA management. We believe that, paradoxically, by fragmenting the view of the disease we will be able to treat our patients more holistically in an individualized way.
Core tip: We are certainly far from consensus on the best form of treatment or on an effective treatment recommendation for osteoarthritis (OA). We still find totally different responses and evolutions in individuals belonging to the same OA phenotype. In this editorial, we propose a fragmented look at each of the many factors or targets involved in the genesis and evolution of OA. Therefore, we propose not the treatment of OA per se but the management of an individual set of targets to achieve personalized OA management through a target-based approach for OA treatment.
