Why One Osteoarthritis Treatment Does Not Fit All: New Review Explains
India: A new review published by Indian authors in International Orthopaedics has highlighted how osteoarthritis (OA) should no longer be viewed as a single disease, but rather as a group of distinct “phenotypes” driven by different biological, structural, metabolic, and pain-related mechanisms. The review argues that identifying these phenotypes could pave the way for precision medicine in OA management.
The paper, titled “Osteoarthritis phenotypes: advancing precision medicine through clinical, structural, and molecular stratification,” discusses how current one-size-fits-all treatment strategies often fail because OA patients exhibit considerable heterogeneity in symptoms, disease progression, imaging findings, and treatment response.
According to the authors, several clinically relevant OA phenotypes have now been recognized, including inflammatory, metabolic, biomechanical, cartilage-subchondral, pain-sensitization, and aging-related phenotypes. Imaging-based and molecular classifications are also emerging, offering deeper insights into disease mechanisms and individualized therapeutic approaches.
Lead author Dr Raju Vaishya (Professor and Senior Consultant Orthopaedic Surgeon at Indraprastha Apollo Hospitals, New Delhi) said, “Osteoarthritis is not a uniform disease entity. Two patients with similar X-ray findings may have completely different biological pathways, symptoms, and treatment responses. Recognizing OA phenotypes is essential if we want to move toward truly personalized care.” He further added, “The future of OA management lies in integrating clinical evaluation with imaging, biomarkers, genomics, and even artificial intelligence (AI)-based clustering tools. This approach may help clinicians identify the right treatment for the right patient at the right time.”
The review also emphasizes the growing importance of molecular endotyping and advanced imaging in understanding OA complexity. However, Dr Abhishek Vaish, a co-author, cautions that several barriers remain before phenotype-based treatment can become routine clinical practice, including overlapping phenotypes, lack of validated biomarkers, and inconsistent evidence from phenotype-targeted trials.
The authors conclude that wider adoption of precision medicine in OA will require standardized phenotype definitions, multicentric validation studies, and integration of multimodal diagnostic tools into daily orthopaedic practice.
Reference:
Vaishya R, Wamuyu EN, Vaish A, Handa R, Kumar D. Osteoarthritis phenotypes: advancing precision medicine through clinical, structural, and molecular stratification. Int Orthop. 2026 May 15. doi: 10.1007/s00264-026-06845-9. Epub ahead of print. PMID: 42141125.
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