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  • Primer
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Osteoarthritis

Nature Reviews Disease Primers volume 11, Article number: 10 (2025) Cite this article

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Abstract

Osteoarthritis is a heterogeneous whole-joint disease that can cause pain and is a leading cause of disability and premature work loss. The predominant disease risk factors — obesity and joint injury — are well recognized and modifiable. A greater understanding of the complex mechanisms, including inflammatory, metabolic and post-traumatic processes, that can lead to disease and of the pathophysiology of pain is helping to delineate mechanistic targets. Currently, management is primarily focused on alleviating the main symptoms of pain and obstructed function through lifestyle interventions such as self-management programmes, education, physical activity, exercise and weight management. However, lack of adherence to known effective osteoarthritis therapeutic strategies also contributes to the high global disease burden. For those who have persistent symptoms that are compromising quality of life and have not responded adequately to core treatments, joint replacement is an option to consider. The burden imparted by the disease causes a substantial impact on individuals affected in terms of quality of life. For society, this disease is a substantial driver of increased health-care costs and underemployment. This Primer highlights advances and controversies in osteoarthritis, drawing key insights from the current evidence base.

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Fig. 1: Healthy and osteoarthritic joint.
Fig. 2: Common osteoarthritis sites.
Fig. 3: Summary of osteoarthritis risk factors.
Fig. 4: Knee osteoarthritis phenotypes.
Fig. 5: Pathological changes in knee joint tissue.
Fig. 6: Neuroanatomy of the pain pathway in osteoarthritis.
Fig. 7: Imaging assistance when clinical findings of symptoms and signs suggest an alternative diagnosis.
Fig. 8: Effect sizes for core, adjunctive and pharmacological treatments for osteoarthritis.

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Acknowledgements

D.J.H. is supported by an NHMRC Investigator Grant Leadership 2. C.D. is supported by the National Key Research and Development Program of China. S.T. is supported by the National Natural Science Foundation of China. A.-M.M. is supported by the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). T.N. is supported by the NIH.

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Author notes

  1. These authors contributed equally: Su’an Tang, Changqing Zhang.

Authors and Affiliations

  1. Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Su’an Tang, Changhai Ding & David J. Hunter

  2. Department of Spinal Surgery, Orthopedic Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Su’an Tang

  3. Institute of Exercise and Rehabilitation Science, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Su’an Tang & Changhai Ding

  4. Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Changqing Zhang, Kai Fu & David J. Hunter

  5. Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Faculty of Medicine and Health Science, Kolling Institute, University of Sydney, Sydney, Australia

    Win Min Oo & David J. Hunter

  6. Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Myanmar

    Win Min Oo

  7. Department of Sport Medicine, Norwegian School Sport Sciences, Oslo, Norway

    May Arna Risberg

  8. Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

    Sita M. Bierma-Zeinstra

  9. Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA

    Tuhina Neogi

  10. Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Inoshi Atukorala

  11. Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Chicago, IL, USA

    Anne-Marie Malfait

  12. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

    Changhai Ding

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Contributions

Introduction (all authors); Epidemiology (all authors); Mechanisms/pathophysiology (all authors); Diagnosis, screening and prevention (all authors); Management (all authors); Quality of life (all authors); Outlook (all authors); overview of the Primer (D.J.H.).

Corresponding authors

Correspondence to Changhai Ding or David J. Hunter.

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Competing interests

D.J.H. is the editor of the osteoarthritis section for UpToDate and co-Editor in Chief of Osteoarthritis and Cartilage. D.J.H. provides consulting advice on scientific advisory boards for Haleon, TLCBio, Novartis, Tissuegene, Sanofi and Enlivex. A.-M.M. is co-Editor in Chief of Osteoarthritis and Cartilage. A.-M.M. provides consulting services or serves on advisory boards for Averitas, Orion, LG, Novartis and Eli Lilly. T.N. is a deputy editor of Osteoarthritis and Cartilage and provides consulting services for Novartis and Eli Lilly. All other authors declare no competing interests.

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Nature Reviews Disease Primers thanks L. Macfarlane, L. Mandl, H. Gudbergsen, M. Goldring and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Tang, S., Zhang, C., Oo, W.M. et al. Osteoarthritis. Nat Rev Dis Primers 11, 10 (2025). https://doi.org/10.1038/s41572-025-00594-6

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