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In the last years, a continuous and growing scientific amount of evidences have been stablishing the need to evolving to the direction of target-based approach for osteoarthritis treatment (figure 01) [01],seeking to treat Osteoarthritis (OA) Phenotypes [02] and their specific and interrelated targets, focusing on keep walking to the desirable personalized medicine. Fig. 02.

Figure 01 Osteoarthritis multifactorial determinants and multitarget approaches:
Combinations and interactions among these many factors.

Figure 02. – Treatment path. From the main etiology OA-related causes (risk factors) was derived 5 OA phenotypes and their specific and interrelated targets of approaches.

The BRASOS board of researchers [brasos.med.br], from current main etiology OA-related causes described above, derived 5 OA phenotypes, their main risk factors and targets of approaches as follow in Table 01. This OA phenotypes classification was based on the perspective that it is necessary to look at first from the person to the joint and not from the joint to the person, since that it is known OA is part of systemic person-state, in whom it is mandatory to consider issues as: age, immune-metabolic balance, mechanical stimuli, gastrointestinal physiology and epigenome/genome expressions, which in isolated or in combination can cause commitment of one or more joints.

Table 01. BRASOS OA phenotypes classification and their targets for approaching

Observation: It is necessary to clarify some points regarding the BRASOS’s OA phenotypes classification presented above:

  1. This is a predominantly clinical classification, except for phenotype 5 (Epigenomic and Genomic-related OA) that requires specific genomic exams.
  2. Within this classification, in order to detect the treatment targets some biochemical tests are necessary, but accessible tests, that is, routine tests.
  3. We do not consider, at the moment, the most sophisticated metabolomics and imaging tests to detect endotypes or even specific imaging patterns that are also important in detailing the classification of phenotypes, since most patients with OA throughout the world cannot routinely perform such procedures.
  4. This is an initial classification of OA phenotypes, a first step that we intend to develop, adding in future updates:
    a) endotypes characterized by biochemical markers derived from cartilage, synovial tissue, bone, holobiome (microbiome-epigenome-genome), miRNA activity, etc.
    b) micro and macrostructural image patterns
    c) social bookmarks
  5. The application developed at the Institute of Research and Technological Innovations of the Faculty of Medical Sciences of Santa Casa de São Paulo will allow, in the improved versions of this our 1st network of guidelines, intertwining of phenotype characteristics and interactions with other data, like any other biochemical, image or social marker. If our 1st network of guidelines already looks at personalized medicine, its improved versions will further individualize the set of interventions for that individual.


⦁ Gustavo C de Campos, Antonio M Tieppo, Cyro S de Almeida Jr, Paulo C Hamdan, Wilson M Alves, Márcia U de Rezende. Target-based Approach for Osteoarthritis Treatment. World J Orthop. 2020 Jun 18;11(6):278-284. DOI: 10.5312/wjo.v11.i6.278. PMID: 32572364

⦁ W E VSpila, Olga Kubassovab, Mikael Boesenbc, Anne-Christine, Bay-Jensend, Ali Mobasheri – Osteoarthritis phenotypes and novel therapeutic targets. Biochemical Pharmacology, Volume 165, July 2019, Pages 41-48. DOI: 10.1016/j.bcp.2019.02.037. PMID: 30831073.