Early treatment of pre-osteoarthritis possible through early diagnosis: Dr Ashwani Maichand
Osteoarthritis is a dangerous disabling disease affecting a large number of people across the world. On one hand, disease-modifying opportunities are limited in case of clinical osteoarthritis. One the other hand, osteoarthritis develops over decades, presenting a gap to amend its course. The etiology of arthritis shows strong association with risk factors of mechanical overload, obesity and joint injury. According to Dr Ashwani Maichand, one of the leading orthopaedic surgeons of Delhi, it is possible to diagnose the disease early. But, for that, it is important to characterize the state of osteoarthritis for early diagnosis, and timely treatment of joint injury and degeneration to reduce osteoarthritis risk. Many pre-OA disease states can be modified, as indicated by epidemiological and genetic studies of OA. It is a long and multifactorial process, replicating an intricate relationship between intrinsic and extrinsic factors. The polygenic nature of the disease with multiple genes contributing small effects has made it difficult to identify the genetic etiologies of OA, although there is evidence for heritability. But, the organised study of big cohorts at increased risk for augmented OA development has the potential to yield new disease-modifying treatments. The potential to characterize and modify the disease from its earliest stages is offered by the joint injury cohorts. These cohorts represent populations that do not meet the classic radiographic or clinical criteria for OA. Subjects have joint pathologies placing them at risk for enhanced osteoarthritis development. Opportunities to explain and treat pre-OA conditions are presented by these populations. It is important to define and characterize pre-OA in its earliest stages for understanding the disease process, and ascertaining potential disease-modifying treatments and gauging their effectiveness. Early diagnosis will permit timely treatment to modify the course of this disease. In order to characterize the pre-osteoarthritic joint, we can use most recent advances in imaging and biochemical biomarkers. Direct imaging of joint tissues has been permitted by advances in optical imaging and magnetic resonance imaging. Direct visualization and palpation of intra-articular structures is allowed by arthroscopy. MRI also permits direct imaging of soft tissues. Conventional MRI permits morphological assessment of cartilage and meniscus, as well as other intra-articular and peri-articular soft tissues for assessment of pre-OA conditions. Bone marrow changes are also seen by the conventional MRI. Apart from this, the earliest structural changes in pre-OA conditions may also be represented by the subsurface alterations to the biomolecular integrity of articular cartilage and menisci. However, they cannot be reliably detected by clinical radiography or conventional MRI. According to Dr Ashwani Maichand, several reviews of qMRI techniques that address this challenge are already available around the world.