Investigating the Diagnosis, Management, and Emerging Therapeutic Advances in Osteoarthritis: A Narrative Review
Syeda Alizay Fatima
Osteoarthritis (OA) is a degenerative joint disease and a major cause of chronic pain and disability worldwide, particularly among older adults. It is characterized by progressive articular cartilage degeneration and structural and biochemical changes in subchondral bone, synovium, ligaments, and periarticular muscles. OA is not simply a mechanical “wear-and-tear” disorder; it is now recognized as a multifactorial disease involving mechanical, genetic, metabolic, and low-grade inflammatory processes. Diagnosis is largely clinical and may be supported by imaging findings such as joint-space narrowing, osteophyte formation, and subchondral sclerosis, while laboratory testing is generally used to exclude inflammatory, infectious, or metabolic arthritides. Management is stepwise: non-pharmacological measures, including exercise and weight loss when appropriate, are foundational; pharmacological therapy may then be added, with topical or oral non-steroidal anti-inflammatory drugs (NSAIDs) commonly used and opioids generally discouraged except in selected circumstances. Intra-articular corticosteroid injections may provide short-term symptom relief, and total joint replacement remains the most effective treatment for appropriately selected patients with end-stage disease. Emerging approaches, including platelet-rich plasma, mesenchymal stem-cell therapies, targeted molecular agents, and disease-modifying osteoarthritis drugs, remain investigational because evidence is inconsistent and disease modification has not been established. This narrative review summarizes current diagnostic approaches, established management strategies, and emerging therapeutic developments in OA, emphasizing the continued need for reliable biomarkers and effective disease-modifying therapies.