Perspective: Empowering osteoarthritis drug development through assessment of synovitis by CE-MRI: A new approach in clinical trials.

Knee osteoarthritis (OA) is a global health challenge with substantial unmet therapeutic needs. Current treatments primarily target symptoms without altering the disease's progression. Synovitis, the inflammation of synovial tissue, is a key driver of both pain and structural changes in OA. This Perspective proposes a paradigm shift, positioning synovial health assessment as a cornerstone in the evaluation of new OA therapies. By doing so, it aims to accelerate development of effective disease modifying OA drugs (DMOADs) and improving patient outcomes. It highlights the potential of contrast enhanced-MRI (CE-MRI) to serve as a surrogate marker for synovial health, offering precise visualization of inflammation and its relationship with disease progression and pain.