Apremilast in osteoarthritis: exploring its therapeutic mechanisms

Osteoarthritis (OA) is increasingly understood as a complex, inflammatory disease rather than a purely mechanical disorder. Apremilast, a selective phosphodiesterase 4 inhibitor approved for psoriatic arthritis, is amongst several new treatment alternatives that target one of the most important inflammatory pathways involved in OA. Apremilast decreases pro-inflammatory cytokines, such as TNF, IL-1 and IL-6, which are central to cartilage degradation and synovial inflammation. This review explores the mechanistic rationale and available evidence supporting the repurposing of apremilast in OA. We highlight its potential to reduce pain and slow structural progression. Although the data are currently scarce, there remains a strong rationale for its repurposing for the treatment of OA based on its safety profile, oral route of administration and positive treatment adherence. Nevertheless, clinical investigation remains limited. Further research is needed to clarify its therapeutic potential and identify patient populations most likely to benefit.