The Osteoarthritis Research Society International (OARSI) 2017 World Congress took place last week under the bright lights of Las Vegas. Fortunately what happened in Vegas won’t be staying in Vegas as Professor David Hunter  from Sydney University and Professor Flavia Cicuttini from Monash in Melbourne have shared some of their highlights with the limbic.

The role of the microbiome

The keynote address on Day 1 of the Congress and other presentations focused on the role of the microbiome in multiple diseases including osteoarthritis.

As obesity is known to affect the host gastrointestinal microbiome, and vice versa, a proposed mechanism by which obesity could predispose to osteoarthritis is through low-grade systemic inflammation, mediated by bacterial endotoxins that migrate from the gut into the circulation.

“There is an increasing research interest in this area and it is very likely that important advances in our knowledge of the microbiome’s role in disease pathogenesis will come in the next couple of years, along with the potential for therapeutic approaches focused on altering the microbiota,” Professor Hunter said.

Hand OA

Dr Sarah Kingsbury presented the results of the UK HERO study comparing hydroxychloroquine to placebo in a randomised trial of people with moderate to severe hand pain and radiographic osteoarthritis over 1 year. The average dose of plaquenil was 320 mg/day. Plaquenil was not more effective than placebo in reducing symptoms or radiographic progression.

Dr Margreet Kloppenburg presented the results of a one-year double-blind European multicentre study of subcutaneous etanacept in 90 patients with erosive inflammatory osteoarthritis. They found no difference in pain at 24 weeks. There was also no significant effect on joint structure.

Dr Dawn Aitkin from Tasmania, presented the results of the HUMOR trial, a single centre randomised double-blind placebo controlled crossover trial of adalimumab in erosive hand osteoarthritis. The research team found no difference to placebo for pain, synovitis or BMLs in patients with erosive hand osteoarthritis.

“Hand osteoarthritis is a major cause of pain and disability, with a magnitude similar to rheumatoid, but with no treatments. These all represent very important results though unfortunately all findings were negative.

However they also highlight the huge unmet clinical need that remains in the treatment of hand osteoarthritis,” Professor Cicuttini said.

 Other highlights

• Professor Ian Harris, author of Surgery, the Ultimate Placebo, provided a sobering presentation on the efficacy (or lack thereof) of many common surgical procedures and the reasons why surgeons continue to perform these ineffective procedures.
• A pre-Congress workshop focused on the increasing importance of public health innovations as it relates to the prevention of osteoarthritis. Both of the major risk factors for this disease – obesity and joint injury – are modifiable and there is good evidence to suggest that we can prevent osteoarthritis.
• An additional pre-Congress workshop was run to help facilitate increased rigour in the conduct of clinical trials in osteoarthritis.

The OARSI 2018 World Congress will be held 26-29 April in Liverpool, UK.