Osteoarthritis (OA) is the most common joint disorder, is associated with an increasing socioeconomic impact owing to the ageing population and mainly affects the diarthrodial joints. Primary OA results from a combination of risk factors, with increasing age and obesity being the most prominent. The concept of the pathophysiology is still evolving, from being viewed as cartilage-limited to a multifactorial disease that affects the whole joint. An intricate relationship between local and systemic factors modulates its clinical and structural presentations, leading to a common final pathway of joint destruction. Pharmacological treatments are mostly related to relief of symptoms and there is no disease-modifying OA drug (that is, treatment that will reduce symptoms in addition to slowing or stopping the disease progression) yet approved by the regulatory agencies. Identifying phenotypes of patients will enable the detection of the disease in its early stages as well as distinguish individuals who are at higher risk of progression, which in turn could be used to guide clinical decision making and allow more effective and specific therapeutic interventions to be designed. This Primer is an update on the progress made in the field of OA epidemiology, quality of life, pathophysiological mechanisms, diagnosis, screening, prevention and disease management.

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Figure 1: Diarthrodial joints in health and OA.
Figure 2: Prevalence and incidence of OA.
Figure 3: Bone remodelling.
Figure 4: Characteristic periarticular bone abnormalities in OA.
Figure 5: Histopathology of the synovial membrane.
Figure 6: Crosstalk between cartilage and the synovium in the pathogenesis of OA.
Figure 7: Osteoarthritis Research Society International guidelines for the non-surgical management of knee OA.


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J.M.-P. and J.-P.P. acknowledge the Chair in Osteoarthritis of the University of Montreal and the Groupe de recherche des maladies rhumatismales du Québec for their support in osteoarthritis research. The authors thank V. Wallis for her assistance with the manuscript preparation.

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Introduction (J.M.-P. and J.-P.P.); Epidemiology (C.C.); Mechanisms/pathophysiology (M.B.G. and S.R.G.); Diagnosis, screening and prevention (F.M.C., G.J. and A.J.T.); Management (A.J.B. and P.G.C.); Quality of life (C.C.); Outlook (J.M.-P. and J.-P.P.); Overview of Primer (J.M.-P. and J.-P.P.).

Correspondence to Johanne Martel-Pelletier or Jean-Pierre Pelletier.

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Competing interests

J.M.-P. is a shareholder of ArthroLab Inc. and consultant for AbbVie, Bioibrica, Ferring, Medapharma, Pierre-Fabre and TRB Chemedica. P.G.C. is a member of the speakers bureau and/or is a consultant for AbbVie, Flexion, Janssen, Lilly, Novartis, Pfizer, Regeneron and Roche. C.C. has received consultancy fees and honoraria from Alliance for Better Bone Health, Amgen, Eli Lilly, GlasoSmithKline, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda and UCB. J.-P.P. is a shareholder of ArthroLab Inc. and is a consultant for AbbVie, Bioibrica, Centrexion, Ferring, Medapharma, Pfizer, Pierre-Fabre, Teva Pharmaceuticals and TRB Chemedica. All other authors declare no competing interests.

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Martel-Pelletier, J., Barr, A., Cicuttini, F. et al. Osteoarthritis. Nat Rev Dis Primers 2, 16072 (2016). https://doi.org/10.1038/nrdp.2016.72

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