Early osteoarthritis – current state of the art

Osteoarthritis (OA) is increasingly recognized as a complex degenerative joint disease that develops under the influence of mechanical, biochemical and genetic factors. The pathogenesis of OA includes a complex of interactions at both cellular and molecular levels, leading to progressive damage to joint tissues – cartilage degeneration, synovial inflammation, remodeling of the subchondral bone, and periarticular changes. In the last decade, the term “early osteoarthritis” has been increasingly mentioned in the scientific literature. The concept of early OA was largely determined by the experience of rheumatoid arthritis treatment. Given the heterogeneity of OA, pathological processes at the cellular and molecular levels, reflecting the early stage of the disease, are diverse and depend on the factors that induce the disease. Symptoms of early OA of the knee joint can be suspected with the appearance of intermittent pain or discomfort in the joint, short-term “initial” stiffness and functional limitations. Clinical examination in most cases reveals pain on palpation of the joint, crepitation or moderate articular effusion. X-ray data are of limited importance at an early stage of the disease, since one of the typical signs of OA – narrowing of the articular gap – may not appear for many years. Quantitative, contrast-enhanced magnetic resonance imaging methods, as well as hybrid methods are used to visualize OA at an early stage. The final goals of developing classification criteria for early OA and early diagnosis of the disease in real clinical practice differ. Early OA represents a “window of opportunity” to prevent disease progression before OA becomes clinically apparent. It is necessary to continue research on the definition and classification of early OA of other localizations. Pharmacological innovations, regenerative methods, and gene therapy represent the future of OA treatment, including at an early stage of the disease. One of the modern drugs that modify the course of OA is Elmosa, a unique combination of glucosamine sulfate, boswellic acids combined with acetyl-L-carnitine and B vitamins.