Osteoarthritis in 2020 and beyond: a Lancet Commission

Osteoarthritis affects 7% of the global population, more than 500 million people worldwide, with women disproportionately affected by the condition.1Global Burden of Disease Collaborative NetworkGlobal Burden of Disease Study 2019 (GBD 2019) results.http://ghdx.healthdata.org/gbd-results-toolDate: 2020Date accessed: November 2, 2020Google Scholar The number of people affected globally rose by 48% from 1990 to 2019, and in 2019 osteoarthritis was the 15th highest cause of years lived with disability (YLDs) worldwide and was responsible for 2% of the total global YLDs.1Global Burden of Disease Collaborative NetworkGlobal Burden of Disease Study 2019 (GBD 2019) results.http://ghdx.healthdata.org/gbd-results-toolDate: 2020Date accessed: November 2, 2020Google Scholar, 2Global Burden of Disease Collaborative NetworkGlobal Burden of Disease Study 2019 (GBD 2019) results. Osteoarthritis —level 3 cause.http://www.healthdata.org/results/gbd_summaries/2019/osteoarthritis-level-3-causeDate: 2020Date accessed: November 2, 2020Google Scholar Although YLDs for osteoarthritis are higher in high Socio-demographic Index (SDI) countries than in middle SDI regions (about 525 vs 220 YLDs per 100 000 population), since 1990 the rate of change in YLDs has been far greater in middle SDI countries than in high SDI countries (89% vs 48%).1Global Burden of Disease Collaborative NetworkGlobal Burden of Disease Study 2019 (GBD 2019) results.http://ghdx.healthdata.org/gbd-results-toolDate: 2020Date accessed: November 2, 2020Google Scholar, 2Global Burden of Disease Collaborative NetworkGlobal Burden of Disease Study 2019 (GBD 2019) results. Osteoarthritis —level 3 cause.http://www.healthdata.org/results/gbd_summaries/2019/osteoarthritis-level-3-causeDate: 2020Date accessed: November 2, 2020Google Scholar Osteoarthritis is a leading cause of disability in older adults and the trends of an ageing population and increasing obesity are likely to compound this. These data are concerning but probably underestimate the true size of the problem. Furthermore, the development of treatments for osteoarthritis has not made comparable progress with that for many other musculoskeletal and chronic non-communicable diseases. Additionally, social determinants, the built environment, and access to health care all have impacts on the disparate disease burden of osteoarthritis, particularly in lower-income and middle-income countries.3Luong ML Cleveland RJ Nyrop KA Callahan LF Social determinants and osteoarthritis outcomes.Aging Health. 2012; 8: 413-437Crossref PubMed Scopus (53) Google Scholar Despite its considerable personal, economic, and societal toll, osteoarthritis is generally neglected. The condition does not feature in global strategic plans for non-communicable diseases, yet osteoarthritis commonly coexists with heart disease, diabetes, and mental health problems and can worsen the morbidity and mortality associated with these conditions.4Veronese N Cereda E Maggi S et al.Osteoarthritis and mortality: a prospective cohort study and systematic review with meta-analysis.Semin Arthritis Rheum. 2016; 46: 160-167Crossref PubMed Scopus (90) Google Scholar Patients with osteoarthritis also report that their concerns are downplayed by health practitioners.5Alami S Boutron I Desjeux D et al.Patients' and practitioners' views of knee osteoarthritis and its management: a qualitative interview study.PLoS One. 2011; 6e19634Crossref PubMed Scopus (84) Google Scholar Therapeutic nihilism may affect patients and practitioners, with misperceptions that osteoarthritis is an inevitable part of ageing and that there are no effective treatments. Current health-care approaches can swing from neglect of core treatments, such as exercise, weight loss, and education,6Hagen KB Smedslund G Østerås N Jamtvedt G Quality of community-based osteoarthritis care: a systematic review and meta-analysis.Arthritis Care Res (Hoboken). 2016; 68: 1443-1452Crossref PubMed Scopus (70) Google Scholar to use of expensive, unproven therapies for late-stage disease; patients are often ill-informed about treatment choices.7Hunter DJ Osteoarthritis management: time to change the deck.J Orthop Sports Phys Ther. 2017; 47: 370-372Crossref PubMed Scopus (15) Google Scholar Myriad therapeutic options8Bannuru RR Osani MC Vaysbrot EE et al.OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis.Osteoarthritis Cartilage. 2019; 27: 1578-1589Summary Full Text Full Text PDF PubMed Scopus (1082) Google Scholar are typically delivered in a fragmented way, paying little heed to the heterogeneity of osteoarthritis and its comorbidities, and too often lead to unintended consequences such as opioid use disorder.9Basedow M Esterman A Assessing appropriateness of osteoarthritis care using quality indicators: a systematic review.J Eval Clin Pract. 2015; 21: 782-789Crossref PubMed Scopus (74) Google Scholar There have been tremendous advances, including in our understanding of the impact and burden of osteoarthritis globally, the pathogenesis of the condition, and the identification of those at risk of disease progression. Opportunities for progress now lie in the application of public health interventions to prevent osteoarthritis, targeting overuse of inappropriate and low-value care, equitable access to existing cost-effective interventions, and identification of low-cost, safe pain relief.10Hunter DJ Bierma-Zeinstra S Osteoarthritis.Lancet. 2019; 393: 1745-1759Summary Full Text Full Text PDF PubMed Scopus (1329) Google Scholar New thinking will be crucial to improve osteoarthritis prevention, management, and policy. The Lancet Commission on osteoarthritis will advance this agenda. Our international team of Commissioners represents diverse disciplines, interests, and backgrounds and has expertise in primary care, rheumatology, physiotherapy, orthopaedics, pain medicine, implementation science, discovery science, epidemiology, health economics, and the lived experience of osteoarthritis. At our initial meetings in September and October, 2020, we established a framework and identified priorities and gaps to examine within a 2-year timeframe for the Commission's work. Driven by the huge impact of this chronic, complex condition, this Commission aims to address key questions at the intersection of policy, public health, primary care, health-service delivery, and research. The Commission will advance an evidence-based, multimodal approach that aims to transform osteoarthritis prevention, management, and policy and provide actionable recommendations for clinicians, policy makers, regulatory agencies, and governments. Our recommendations will aim for health, societal, and economic benefits and provide a roadmap to a world free from osteoarthritis-related disability. DJH is a National Health and Medical Research Council (NHMRC) Investigator Leadership Fellow and receives consulting fees from Merck Serono, TLC Bio, Tissuegene, Lilly, and Pfizer for osteoarthritis-related scientific advisory roles. LM has received speaking and consultancy honoraria from Bristol Myer Squibb, Pfizer, Lilly, and AbbVie and research support from AbbVie, Lilly, and Janssen, all for non-osteoarthritis-related topics. MC is a practising part-time general practitioner. The Commissioners for the Lancet Commission on Osteoarthritis are: Nigel Arden, Jocelyn Bowden, Andrew Briggs, Leigh Callahan, Cyrus Cooper, Marita Cross, Krysia Dziedzic, Rolando Espinosa, Kai Fu, Francis Guillemin, David J Hunter (Co-Chair), Teppo Järvinen, Stefan Lohmander, Elena Losina, Lyn March (Co-Chair), Heather McKay, YiFang Mei, Stephen Messier, Ali Mobasheri, Mosedi Namane, Tuhina Neogi, Michael Nicholas, George Peat, Ester Penserga, May Arna Risberg, Saeid Safiri, Saurab Sharma, Regina Sit, Rosa Weiss Telles, and Marianna Vitaloni. Osteoarthritis in 2020 and beyond – Authors' replyWe thank Manon Pigeolet and colleagues for their thoughtful suggestions. We agree that the Lancet Commission on Global Surgery and the Lancet Commission on Diagnostics are critically relevant in the osteoarthritis field, and we look forward to interacting with both groups. Full-Text PDF Osteoarthritis in 2020 and beyondWe applaud the bold move of creating the Lancet Commission on Osteoarthritis, an often forgotten illness.1 Globally applicable and acceptable solutions need transdisciplinary action, which the Commission has clearly thought about, given its diverse professional make-up. In this line of thought, we would like to highlight two other Lancet Commissions, the Lancet Commission on Global Surgery and the ongoing Lancet Commission on Diagnostics.2 Full-Text PDF