Clinicians recognize that the diagnosis of osteoarthritis is established late in the disease process, maybe too late to expect much help from disease modifying drugs. Despite efforts over the past decades to develop markers of disease, imaging procedures and biochemical marker analyses need to be improved and possibly extended with more specific and sensitive methods to reliably describe disease processes, to diagnose the disease at an early stage, to classify patients according to their prognosis, and to follow the course of disease and treatment effectiveness. In the coming years, a better definition of osteoarthritis is expected by delineating different phenotypes of the disease. Treatment targeted more specifically at these phenotypes might lead to improved outcomes. 

Complex algorithms to hunt for disease subtypes

The APPROACH consortium contributes to this by combining biomedical data for >10,000 patients and controls from eight existing cohorts into a unified bioinformatics platform. With the help of complex algorithms, bioinformaticians will comb through this central database to identify subtypes or phenotypes of osteoarthritis. These subtypes will then be validated in a longitudinal clinical study, using existing and newly-developed biological markers. APPROACH will concentrate on knee OA as this has a high clinical burden and is a very common form of OA that has been extensively examined in large cohorts with, amongst other things, x-ray and MRI measurements taken using standardized protocols.  A number of the partners in APPROACH have been involved in the establishment of cohort studies in OA, that include a large number of OA knee patients as a primary interest and inclusion requirement, or as a comorbidity in cohorts that have been created for other reasons such as hand OA, overweight, or generalized OA.

A step towards more personalised medicine for patients

The results of this 5.5 year program will be used to support the selection of patient cohorts for new disease modifying osteoarthritis drug (DMOAD) clinical trials. Patients will reap the greatest benefits as the identification of disease subtypes will lead to improved diagnostic / prognostic tools and more effective, personalised treatments.

  1. Wolf AD, Pfleger B. Burden of Major Musculoskeletal Conditions. Policy and Practice. Special Theme-Bone and Joint Decade 2000-2010. Bulletin of the World Health Organization 2003, 81 (9): 646-656.