Osteoarthritis (OA) remains the most challenging arthritic disorder, with a high burden of disease and no available disease-modifying treatments. Symptomatic early-stage OA of the knee (the focus of this Review) urgently needs to be identified and defined, as efficient early-stage case finding and diagnosis in primary care would enable health-care providers to proactively and substantially reduce the burden of disease through proper management including structured education, exercise and weight management (when needed) and addressing lifestyle-related risk factors for disease progression. Efforts to define patient populations with symptomatic early-stage knee OA on the basis of validated classification criteria are ongoing. Such criteria, as well as the identification of molecular and imaging biomarkers of disease risk and/or progression, would enable well-designed clinical studies, facilitate interventional trials, and aid the discovery and validation of cellular and molecular targets for novel therapies. Treatment strategies, relevant outcomes and ethical issues also need to be considered in the context of the cost-effective management of symptomatic early-stage knee OA. To move forwards, a multidisciplinary and sustained international effort involving all major stakeholders is required.

骨关节炎 (OA) 仍然是最具挑战性的关节炎疾病，具有很高的疾病负担，并且没有可用的疾病缓解治疗方法。膝关节有症状的早期 OA（本综述的重点）迫切需要识别和定义，因为初级保健中有效的早期病例发现和诊断将使医疗保健提供者能够主动并大幅减轻疾病负担通过适当的管理，包括结构化教育、锻炼和体重管理（在需要时）以及解决与生活方式相关的疾病进展风险因素。正在努力根据经过验证的分类标准来定义有症状的早期膝关节 OA 患者人群。此类标准，以及疾病风险和/或进展的分子和成像生物标志物的鉴定，将能够进行精心设计的临床研究，促进介入试验，并帮助发现和验证用于新疗法的细胞和分子靶标。治疗策略、相关结果和伦理问题也需要在对有症状的早期膝关节 OA 进行成本效益管理的背景下加以考虑。为了向前迈进，需要所有主要利益相关者参与的多学科和持续的国际努力。