Thread by @rheum_cat

Dr Carla Scanzello on OA #ACR22 #ReviewCourse

A review of the radiographic features that show us the extent of damage that's accrued over time

BUT they don't tell us anything about the pt's experience with the OA illness

There's only one slide on an important and big concept: pain sensitization and its impact on the OA pain experience

See pioneering work in humans by @Tuhina_Neogi & colleagues

#ACR22 #ReviewCourse

What has MRI taught us about OA?

🦴What OA isn't: a disease of solely cartilage

🔍Important in identifying potential tissue sources of pain, e.g., synovitis, bone marrow lesions

#ACR22 #ReviewCourse

What about US for OA?

pubmed.ncbi.nlm.nih.gov/32414954/

#ACR22 #ReviewCourse

.@eular_org recs on imaging for OA

Remember that x-ray is not required for diagnosis

#ACR22 #ReviewCourse

Mgmt of OA: the cornerstone is patient education

What does it mean? Mgmt of expectations without needlessly discouraging pts.

👉Against the "wear & tear" language; pubmed.ncbi.nlm.nih.gov/30067920/
#ACR22 #ReviewCourse

Weight mgmt in OA:

👉OAI study, results pertinent to the knee (structural & symptom outcomes)
pubmed.ncbi.nlm.nih.gov/35245415/

#ACR22 #ReviewCourse

Encourage physical activity. Better education needed that this does not worsen wear & tear

🚶‍♀️🚶Work from @HiralMaster @dankwhitept: daily walking doesn't increase risk of jt replacement at 5 yrs
pubmed.ncbi.nlm.nih.gov/34175271/

#ACR22 #ReviewCourse

Supervised exercise with GLA:D: a/w ⬇️analgesic use

💊@jbthorlund study: pubmed.ncbi.nlm.nih.gov/32958468/

#ACR22 #ReviewCourse

💉IACS: effective? in short term, yes

Safe? OAI study with possible ⬆️risk of knee replacement

BUT from @BU_BMC_Rheum an active comparator design using IA hyaluronic acid did not show ⬆️risk. Thx to @Tuhina_Neogi @MikeLaValley8 for input on the more valid study design

#ACR22

@BU_BMC_Rheum @Tuhina_Neogi @MikeLaValley8 Viscosupplementation?

Meta analyses have not supported its efficacy

#ACR22 #ReviewCourse

@BU_BMC_Rheum @Tuhina_Neogi @MikeLaValley8 PRP: trials have not had standardized preparations & had issues with blinding

@KimBennell study was null after addressing these limitations

#ACR22 #CourseReview

@BU_BMC_Rheum @Tuhina_Neogi @MikeLaValley8 @KimBennell Back to work from @Tuhina_Neogi and colleagues: can we target pain sensitization?

Recall the anti NGF program. Tanezumab effective for pain improvement.

Other targets beyond NGF in development!

#ACR22 #CourseReview

A future for DMOADs?

#ACR22 #CourseReview

for more on this topic, see the talk from Dr Scanzello presented last year & in better health circumstances (get well soon!!)

https://twitter.com/rheum_cat/status/1457304206801506305?s=20&t=JiRSLKecrKq7yRdv2M8GGA

#ACR22

This is my favorite microphone exchange:

@McCarthyProf: You know what question I'm going to ask you, don't you?

C.S.: yes, I do.

#ACR22

@McCarthyProf The actual question is the role of Ca++ crystals and calcification/mineralization in OA as a targetable phenotype

Unmet need in OA! Sounds like people should be funded to study this in detail #HintHint

#ACR22