Target-based approach for osteoarthritis treatment.

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.

Physical activity prevents blood pressure increases in individuals under treatment for knee osteoarthritis.

The aim of this study was to assess the role of physical activity in blood pressure (BP) in individuals with knee osteoarthritis. We compared 136 participants under treatment for primary knee osteoarthritis (age=67.6±9.6 years) allocated to the sedentary-sedentary, active-sedentary, sedentary-active, and active-active groups depending on their levels of daily physical activity before and after follow-up. Their BP, BMI, and endurance performance (6-min walking test) were compared during 12 months of follow-up. The sedentary-sedentary group had increased systolic BP (11±3 mmHg), and the active-sedentary group had increased systolic (12±4 mmHg) and diastolic BP (5±1 mmHg) during follow-up. By contrast, the sedentary-active group maintained systolic BP and showed reduced diastolic BP (5±2 mmHg), and the active-active group maintained both systolic and diastolic BP. Positive effects on BP were accompanied by improvements in endurance performance and BMI in the sedentary-active group (endurance performance=8.5±2.7%; BMI=9.3±3.6%) and the active-active group (endurance performance=2.9±0.9%; BMI=3.8±2.0%), which did not occur in the sedentary-sedentary and active-sedentary groups. These results suggest a positive role of high levels of daily living physical activity in the prevention/management of hypertension in individuals with knee osteoarthritis.