Defining the early-stage OA patient: the EsSKOA initiative with Dr Armaghan Mahmoudian

This episode of Joint Action explores the groundbreaking EsSKOA initiative, led by Dr. Armaghan Mahmoudian, which aims to define early-stage symptomatic knee osteoarthritis (OA) before structural damage is visible on X-rays. The conversation centers on a critical challenge in OA research: despite decades of trials for disease-modifying drugs, none have succeeded—largely because trials have targeted patients with established, radiographic OA, where the disease may already be too advanced to reverse. Dr. Mahmoudian emphasizes that early OA should be defined not by imaging alone, but by the patient’s lived experience—symptoms like pain, stiffness, and functional limitations—making the distinction between 'disease' (structural changes) and 'illness' (symptoms) fundamental. The initiative uses a rigorous, multi-phase framework to develop classification criteria that distinguish early symptomatic OA from mimickers (like inflammatory arthritis) and established OA, with the goal of enabling smarter clinical trials that enroll patients at a more modifiable stage. A key insight is that early symptoms are not a death sentence but a window of opportunity for proactive intervention through movement, strength training, and early clinical guidance.