By Elaine F. Chan, PhD, VP of Client & Scientific Solutions at MMI
The OARSI World Congress is in the books — and as always, West Palm Beach delivered not just sunshine but a genuinely energizing mix of science, strategy, and serendipitous hallway conversations. Here are a few themes that stuck with me, through two lenses: the imaging scientist and the clinical trials pragmatist.
What’s New and Exciting in OA Imaging
As someone who lives and breathes medical imaging, the sessions that caught my attention weren’t just incremental updates — a few represented genuine leaps forward.
On the ultrasound side, emerging techniques are now showing the ability to differentiate between bone cortex and marrow layers, a capability that has historically been out of reach for this modality. If this holds up in broader validation, it opens meaningful new possibilities for accessible, radiation-free joint assessment.
MRI quantification continues to expand beyond the traditional triumvirate of cartilage, synovial volume, and bone shape. More work is now incorporating knee adjacent subcutaneous fat (kaSCF) measurements and distinguishing between anterior vs. posterior Hoffa fat pad. These structural features may carry value in understanding OA phenotyping and progression. The field is also slowly making progress on the reproducibility of T2 and T1rho mapping, particularly when MSK-QMIC guidelines are followed, which matters enormously for longitudinal, multi-center clinical trial applications.
The Pipeline Is Alive!
There was unmistakable energy around the clinical pipeline at this year’s meeting. Some of the companies presenting or discussed across sessions included Genascence Corporation (GNSC-001), Biosplice Therapeutics (Lorecivivint), Eupraxia Pharmaceuticals Inc. (EP-104IAR), Enlivex (Allocetra), Paradigm Biopharmaceuticals (Zilosul), ORTHOTROPHIX, INC. (TPX-100), LEVICEPT LTD (LEVI-04), PEPTINOV (PPV-06), Pacira BioSciences, Inc. (PCRX201), Xalud Therapeutics, Inc. (XT-150), 4Moving Biotech (4P004), Kolon TissueGene, Inc. (Invossa), and SUN PHARMA (MM-II), spanning both symptom-modification and disease-modification approaches. The breadth and diversity of mechanisms here is genuinely encouraging.
GLP-1s: An Unexpected OA Story Worth Watching
One of the more compelling data points came from the Lose-It trial, which showed a trend toward increased joint space width of 0.22 mm over 52 weeks for GLP-1 receptor agonists compared to 0.06 mm in the placebo arm. The anti-inflammatory properties of GLP-1RAs are generating real interest in whether this drug class — already transforming metabolic medicine — may also have a meaningful role in slowing OA progression. The key will be to convince the drug developers to consistently acquire imaging in these trials so that we can start building the imaging evidence.
Rethinking the Language and Framework of Clinical Trials
A few conversations and presentations pushed me to think differently about how we frame OA drug development.
Philip Conaghan raised an important provocation during the Clinical Trials Symposium: is the term “disease-modifying” OA drug actually still serving us? The suggestion to shift toward “tissue-modifying” language is more than semantic. It reflects a more honest framing of what these therapies may realistically achieve and how regulators and payers are likely to evaluate them.
Also gaining traction: the concept of “reasonably likely surrogate endpoints” as a path forward in trials — endpoints supported by converging evidence that they are reasonably likely to predict clinical benefit, even without full formal validation. This is a pragmatic and potentially important regulatory concept for a field where validated structural endpoints remain elusive.
And on screen failure rates: a great summary from NBCD examined screen fail reasons across eight OA trials, highlighting the outsized proportion of fails driven by radiographic Kellgren-Lawrence criteria.
“Investigator training and smarter eligibility design aren’t just operational nice-to-haves — with screen fail rates in some programs pushing 75%, they are a financial and scientific imperative.”
Closing Thought
OARSI consistently does what the best scientific meetings should: it challenges assumptions, surfaces emerging data before it becomes consensus, and most importantly, gets the right people in the same room to discuss progress and lessons learnt in clinical trials.
What struck me most, though, is how much of the conversation centers on questions we at Medical Metrics are uniquely positioned to help answer. After years of supporting OA clinical trials across imaging endpoints, we’ve accumulated a remarkable depth of data across modalities, different joints, trial designs, and patient populations. In this era of AI, the insights sitting in that multi-trial dataset have real potential to inform the next generation of trial design, endpoint selection, and phenotype stratification.
If any of the themes from this meeting resonated with you — whether it’s the evolving role of structural biomarkers, the challenge of screen failure rates, or the push toward reasonably likely surrogate endpoints — I’d love to explore what we might uncover together. The data is there. Let’s dig in.
Elaine F. Chan, PhD
Elaine F. Chan, PhD is a leader in imaging science and clinical trial research at Medical Metrics, Inc. She has broad expertise in musculoskeletal imaging, spanning both qualitative and quantitative approaches, and applies that expertise across a range of clinical trials including DMOAD, pain, and other musculoskeletal indications. As Vice President of Client & Scientific Solutions, she leads the scientific teams as well as customer success and business development, working closely with pharmaceutical and biotech sponsors to advance imaging solutions for musculoskeletal disease.
Read Dr. Chan’s original post on Linked in here: https://www.linkedin.com/pulse/reflections-from-oarsi-2026-scientist-pragmatist-elaine-f-chan-phd-e8noc/
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