The Australian Osteoarthritis Summit 2025: Driving Impactful Research, held at the University of Melbourne in March, brought together around 80 researchers, clinicians and other stakeholders to hear about the progress made in osteoarthritis (OA) research and clinical translation since the last meeting and to set new research priorities. 

It was the eighth summit since the first was held in 2012. 

Professor Kim Bennell APAM (left), a physiotherapist and researcher at the University of Melbourne, Director of the Centre for Health, Exercise and Sports Medicine there and a member of the Summit Steering Group, said the attendees came from across Australia and represented the key research groups working on different aspects of osteoarthritis. 

‘It was good—a mix of early-career and experienced researchers. 

‘It’s evident that we punch above our weight in Australia in terms of research outputs given the funding we get,’ Kim said. 

Australian research in the past five years 

The morning sessions focused primarily on research advances made over the past five years. 

According to priorities initially identified at the 2017 Australian Osteoarthritis Summit and published in 2019 in BMC Musculoskeletal Disorders (Hunter et al 2019), these areas of research included treatment adherence and behaviour change, disease modification and prevention of OA. 

Professor Chris Little, a researcher at the Kolling Institute at the University of Sydney, talked about preclinical ‘basic’ research efforts focused mostly on OA pathophysiology and disease mechanisms in animal models or tissue culture along with developing new tools for repairing joint damage and ‘treatment’ studies. 

‘Most of our preclinical pathophysiology studies are looking very early in the disease, even pre-OA,’ Chris told the audience. 

‘We think of them as treatment targets but maybe they’re better thought of as prevention studies. 

‘Instead of applying what we discover in a mouse to a 69-year-old postmenopausal woman with moderate to severe knee OA, we could start applying it to earlier stages of disease and align our clinical populations with our animal studies.’ 

Professor Kay Crossley MACP, an APA Titled Sports and Exercise Physiotherapist and researcher at the La Trobe Sport and Exercise Medicine Research Centre, summarised some of the current clinical translation research into disease prevention. 

Kay noted that the two main prevention opportunities for knee OA are weight loss and injury prevention, with a secondary target of preventing progression to OA in people who have already sustained an injury. 

Kay said that weight loss interventions need to be tested in larger trials—like the TOPS study, in which more than 1200 women over 50 in New South Wales and the USA will be assessed to see if weight loss and exercise can prevent OA from developing—and suggested that OA researchers team up with researchers in other fields to gain access to larger clinical studies. 

‘There are people doing studies on weight loss for many other conditions. 

‘We could collaborate and say, “Hey, while you’ve got them here, let’s try and get some imaging of their knees and see what’s happening to them” rather than reinventing the wheel. 

‘It’s a space with a lot of opportunity.’ 

Another opportunity lies in understanding how to delay or prevent knee OA from developing after an injury like an anterior cruciate ligament rupture. 

Kay talked about research programs she and her colleagues at La Trobe University are conducting, including the Prep-to-Play study, which is aimed at reducing injuries in female Australian Football players. 

‘We know that injury prevention programs work; you can reduce knee injuries by 30 to 60 per cent. 

‘Most programs are freely available online so there’s no reason why sporting clubs and athletes aren’t using them but they’re not and injury rates are rising alongside the personal and societal costs of injury. 

‘People who tear their anterior cruciate ligament have seven times the risk of having a total joint replacement compared to somebody who didn’t,’ Kay said. 

Professor Rana Hinman APAM, deputy director of the University of Melbourne’s Centre for Health, Exercise and Sports Medicine, took the stand to talk about treatment adherence and behavioural change, an area of research she has been closely involved in and the top priority from the 2017 Australian Osteoarthritis Summit. 

She said Australia is leading the way in this space, with strong collaborations both within Australia and internationally. 

Rana noted that despite many studies and systemic reviews, more high-quality research is needed to tease out the relationships between treatment adherence and outcomes such as improvements in pain and function, particularly for exercise-based interventions. 

‘We might change adherence with an intervention but that doesn’t always translate into improvements with symptoms,’ Rana said, suggesting that the focus needs to shift towards identifying treatment responders and non-responders early and whether a person’s adherence to an intervention could be predicted. 

‘Adherence often declines over time and sometimes there’s a group of people who are poorly adherent from the get-go. 

‘Can we predict those people? 

‘Unfortunately, we are seeing little ability to do that at the moment,’ Rana says. 

However, it was not all negative. 

Rana said there is a lot more understanding of how to best deliver information, using empowering or participatory discourse rather than impairment discourse to help engage consumers in effective care, and pointed to the development of self-management toolkits and e-learning as effective strategies for consumers and clinicians. 

Professor David Hunter speaks to summit attendees (Image: Kim Bennell, Centre for Health Exercise and Sports Medicine, The University of Melbourne).

Disease modification was discussed from both a preclinical and a clinical perspective. 

Associate Professor Indira Prasadam, a researcher at Queensland University of Technology’s Centre for Biomedical Technologies, talked about disease-modifying drugs and the importance of doing preclinical studies to evaluate the safety and toxicity of drugs, allow optimisation and provide understanding of the mechanism of action. 

Indira outlined a number of studies looking at reversing and preventing inflammation, noting that drugs being tested for rheumatoid arthritis might also have application for OA and that it’s not enough to simply inhibit inflammation; it needs to be resolved—that is, the immune cells involved need to be cleared away from the joint and tissue damage repaired by specific repair molecules and cells. 

‘The direction we are going in is either trying to alter the inflammation or modifying the current counter-protection side of things. 

‘It could be one molecule that can do both these things or we may need two molecules,’ Indira said. 

‘Rheumatoid arthritis can now be treated with disease-modifying drugs and the same with Parkinson’s disease. 

‘I think OA could be next.’ 

Professor Flavia Cicuttini, head of rheumatology at the Alfred Hospital in Melbourne, finished the research overview with a brief history of OA research. 

‘Those of us who have been around for a long time got excited in the 1990s when MRI turned up [as an imaging option for OA]. 

‘We thought we could finally move away from X-rays, do lots of research and develop treatments. 

‘Instead, MRI and the advent of MRI-type structural research meant that we suddenly had to unlearn a lot of our so-called knowledge,’ Flavia said. 

She explained that it has now been recognised that OA is not one disease, but a complex condition, with drivers differing across and within the joints. 

‘We are going to need to develop targeted therapies and it will be a challenge,’ Flavia said, pointing to opportunities in genomics and proteomics and the use of ‘big data’ analysis to identify new targets. 

Following the research presentations, Arthritis Australia’s Director of Policy and Advocacy Louise Hardy touched on some important points, including the expected 32 per cent increase in people living with OA by 2040 and associated health system expenditure. 

Arthritis Australia collaborated with Research Australia to develop a national research strategy, with recommendations for both advocacy and research investment targets. 

New research priorities 

The afternoon of the summit was dedicated to identifying future OA research priorities. 

Led by University of Sydney researchers Dr Jocelyn Bowden and Dr Carina Blaker from the Summit Steering Group, the first session outlined the process used to identify priority areas of research. 

In the second session, breakout groups discussed the top-ranked themes and topics. 

Jocelyn and Carina said that a survey completed prior to the summit by 288 participants—including consumers, clinicians, researchers, carers and industry representatives—identified eight themes: disease process, disease burden, prevention, general management, non-surgical management, pharmacological and alternative therapies, surgical management and health services. 

Each was broken down further into more detailed priorities and these were then ranked, both within each theme and overall. 

The final top-ranked priorities were: 

• treatment—strategies to prevent the structural progression of established osteoarthritis
• prevention—reverse established osteoarthritis via regeneration or healing damaged cartilage
• disease—criteria to identify who would benefit most from joint replacement surgery
• surgery—effective treatments to prevent or delay joint replacement surgery
• non-surgery—effective and safe pain medications for osteoarthritis
• treatment—understanding what causes osteoarthritis
• disease—figuring out which treatments for osteoarthritis are most effective. 

Many of these priorities were also ranked across more than one theme. 

The Summit Steering Group plans to use the suggestions and comments collected during the breakout sessions to come up with a comprehensive set of priorities and an action plan, which will be published in an academic journal along with the process used before and during the summit to identify, rank and discuss the priorities.

 ‘Once we’ve got that, we can all see where our research fits and whether it aligns with these priorities,’ Kim says. 

‘When we’re putting in for grants, we can say, “Well, I’m doing something that is aligned with the priorities that have been set by consumers and clinicians using a robust process. It shows that we have consulted the stakeholders, we are listening and we can research the areas that are deemed by the stakeholders and consumers to be important.” 

‘The aim then is to improve outcomes for the millions of people in Australia and worldwide living with this chronic painful condition.’ 

Reference: Hunter et al (2019). Developing strategic priorities in osteoarthritis research: proceedings and recommendations arising from the 2017 Australian Osteoarthritis Summit. BMC Musculoskelet Disord 20, 74. doi.org/10.1186/s12891-019-2455-x