Osteoarthritis in 2020 and beyond – Authors’ reply

We thank Manon Pigeolet and colleagues for their thoughtful suggestions. We agree that the Lancet Commission on Global Surgery and the Lancet Commission on Diagnostics are critically relevant in the osteoarthritis field, and we look forward to interacting with both groups.

The general guidance for osteoarthritis is that the diagnosis is a clinical one,
for which imaging can be used if other diagnostic possibilities need to be ruled out or in the latter stages of disease when staging for surgery. However, the use of imaging in general, particularly MRI in developed nations, is such that it often leads to further unnecessary interventions, such as low-value knee arthroscopy.

In addition, there are many opportunities for adequate decision support around the appropriateness of surgery and other less invasive presurgical interventions.

We appreciate the suggestion to include a paediatric orthopaedic surgeon and recognise the importance of paediatric conditions that might predispose to osteoarthritis. We similarly recognise that prevention is a key missed opportunity in osteoarthritis, and the selection of some of the commissioners has been based upon their expertise in areas of prevention—specifically those targeting joint injury and people above a healthy weight. Striving for a diversity of expertise, backgrounds, and geography with adequate representation of individuals from low-income and middle-income countries among the commissioners, while balancing the constraints of a manageable group size, means we could not, unfortunately, include every area of expertise.

DJH is a National Health and Medical Research Council Investigator Leadership Fellow and reports receiving consulting fees from Merck Serono, TLC Bio, Tissuegene, Lilly, and Pfizer for osteoarthritis-related scientific advisory roles. LM reports receiving speaking and consultancy honoraria from Bristol Myers Squibb, Pfizer, Lilly, and AbbVie, and research support from AbbVie, Lilly, and Janssen, all for non-osteoarthritis-related topics. MC is a practising part-time general practitioner and Senior Editor at The Lancet. The commissioners for the Lancet Commission on Osteoarthritis are listed in the appendix.