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Osteoarthritis — master index¶
Last audited: 2026-08-31 · status: built · literature sweep 2026-10-29 (pages touched this sweep remain draft pending independent audit)
Build at a glance: 18 wiki pages · 464 unique PubMed records · 20 live status-verified trial registrations · 6 landmark notes · 22 guideline records · 100+ statistical estimates · 5 verified organizations · 22 open questions.
The condition in five sentences. Osteoarthritis is a heterogeneous whole-joint disorder involving cartilage, subchondral bone, synovium, ligaments, muscle and sensory pathways, not a synonym for passive cartilage “wear and tear” (Bijlsma 2011, PMID 21684382). GBD estimated 595 million cases in 2020 (95% UI 535–656 million), 7.6% of the global population, and projected joint-specific case growth through 2050 (GBD 2021 Osteoarthritis Collaborators 2023, PMID 37675071). Symptoms and images overlap incompletely because cartilage is aneural and pain can arise from synovium, bone, periarticular tissue and sensitized neural processing (Bedson 2008, PMID 18764949; Dainese 2022, PMID 34968719). Exercise, education and weight management when relevant are core care; topical/oral NSAIDs are adjuncts selected by risk, while opioids and many injections yield smaller net benefits than their use implies (Kolasinski 2020, PMID 31908149; da Costa 2021, PMID 34642179). Arthroplasty can deliver large benefit in selected advanced symptomatic disease but also complications and revision exposure, and no approved DMOAD has yet shown an accepted combination of durable structure and patient-important improvement (Skou 2015, PMID 26488691; Cho 2021, PMID 34848838).
Start here: overview. Frontier: OPEN-QUESTIONS.md. Growth history: LOG.md.
Reading paths¶
| Reader / question | Path |
|---|---|
| New to OA | Overview → diagnosis → epidemiology |
| Mechanisms researcher | Cartilage, bone and synovium → pain mechanisms → genetics → biomarkers |
| Nonsurgical treatment | Exercise and weight → pharmacology → injections → guidelines |
| Joint-specific care | Knee OA or hip OA → surgery |
| Drug development | Disease modification → biomarkers → trials landscape → open questions |
| Safety / differential | Diagnosis → red flags and safety |
| Lived experience / policy | Patient experience → burden → patient-voice themes |
| Quantitative lookup | Statistics → bibliography |
Pages¶
The table is the canonical page list. All 18 pages were curated after the 2026-08-31 independent audit of the deepening pass. The 2026-10-15 sweep returned 8 pages to draft. The 2026-10-22 sweep also updated pharmacology; 9 pages are now draft pending a different-engine audit and the other 9 remain curated.
| File | Scope | Status |
|---|---|---|
| overview.md | Whole-joint model, burden, pain and treatment map | curated |
| diagnosis-and-classification.md | Clinical/radiographic diagnosis, grading, differential and phenotypes | curated |
| epidemiology-and-burden.md | Joint-specific prevalence, disability, costs and projections | curated |
| cartilage-bone-and-synovium.md | Matrix loss, bone remodeling, inflammation and osteophytes | curated |
| pain-mechanisms-and-sensitization.md | Nociception, bone/synovial pain, central amplification and discordance | curated |
| genetics-and-risk-factors.md | GWAS, age, injury, alignment, obesity, sex and occupation | curated |
| knee-osteoarthritis.md | Phenotypes, bracing, injection, osteotomy and arthroplasty pathway | curated |
| hip-osteoarthritis.md | Diagnosis, biomechanics, conservative care and replacement | draft |
| exercise-weight-and-self-management.md | Exercise dose, weight change, education and behavioral support | draft |
| pharmacologic-treatment.md | Topical/oral drugs, duloxetine, opioids and safety | draft |
| injections-and-orthobiologics.md | Steroid, hyaluronate, PRP and evidence controversy | draft |
| surgery-and-joint-replacement.md | Selection, arthroplasty, osteotomy, outcomes and revisions | draft |
| disease-modifying-therapies.md | DMOAD targets, trial failures and structural endpoints | draft |
| guidelines.md | ACR/AF, OARSI, NICE and disagreement | draft |
| biomarkers-and-imaging-markers.md | Biochemical, MRI, radiographic and prognostic candidates | draft |
| clinical-trials-landscape.md | DMOAD, metabolic, analgesic, device and surgical trials | draft |
| patient-experience-and-advocacy.md | Pain, mobility, work, delay to surgery and priorities | curated |
| red-flags-and-safety-concerns.md | Hot joint, fracture, malignancy, rapidly destructive disease and drug harms | curated |
Literature layer¶
| Artifact | Contents | Status |
|---|---|---|
| BIBLIOGRAPHY.md | 492 unique records, topic-grouped with tags and cited-by mapping | built |
| notes/ | 6 deep notes: GBD, ACR/AF, IDEA, repeated triamcinolone, RESTORE and TKR comparative effectiveness | built |
| guidelines/REGISTRY.md | 25 current/superseded records (ACR 2026 summary, AAOS hip 2023 and EUROVISCO added 2026-10-15), profiles, disagreements and watch list | built |
| statistics/STATISTICS.md | Burden, prevalence, risk, mechanisms and treatment effects with populations/methods | built |
| patient-voice/README.md | Method, public-source ethics and interpretation | built |
| patient-voice/organizations.md | 5 live-verified organizations/resources | built |
| patient-voice/themes.md | 12 multi-source themes and outcome implications | built |
| patient-voice/sources.md | Annotated qualitative, preference, decision-aid and public sources | built |
| OPEN-QUESTIONS.md | 22 stable tiered questions and 12 “dots not yet connected” junctions | built |
Curation state¶
This condition completed its full build on 2026-08-28, underwent an initial separate audit on 2026-08-30, and passed its repair audit on 2026-08-31. A same-calendar-day deepening pass (2026-08-31) then extended all 18 pages with landmark trial effect sizes, competing guideline class/level positions, quantified epidemiology, mechanism detail and explicit both-sides controversies, without deleting the prior verified text. Pages were returned to draft because a different engine must re-audit newly added claims. See LOG.md.
2026-10-15 sweep. The main finding is the ACR 2026 update summary, posted 2026-09-14 with the full manuscript not yet published. It adds a conditional recommendation for GLP-1 RA in knee OA with obesity and reverses direction on massage, on methotrexate for erosive hand OA, and on glucosamine/chondroitin. The sweep also added TRIUMPH-1 (retatrutide, knee-OA pain), RACER-Knee (robotic TKR, no benefit) and a large hip-precautions RCT. It corrected OQ-23, which had omitted the positive PROMOTE methotrexate trial. See LOG.md.
2026-10-22 sweep. Added comparison-specific rehabilitation evidence, German embolization surveillance and a recruiting UK sham-comparison target. Refreshed the ACR pharmacology summary, catalogued previously omitted VA/DoD and EULAR updates, and added registry and patient-organisation material. No new landmark note; no question closed. Search manifest · log.
2026-10-29 sweep. A 12-month sham-controlled genicular-artery embolization RCT is null, and a review pooling three sham RCTs is also null; GEKO remains the larger pending replication. A PRP structural meta-analysis is inconsistent. A referred-care cohort shows sex differences in TKA willingness and surgeon recommendation. GLP-1 cost-effectiveness was added as a 2025 catch-up. No new landmark note; no question closed. Search manifest · log.