ESORT Project
Early symptomatic Osteoarthiris RegisTer

ESORT Project

Project Leader

Alberto Migliore Alberto - Osp S. Pietro Roma,

GdS SIR sull’osteoartrosi


Osteoarthritis (OA) is one of the major causes of morbidity and disability and entails high socio-economic costs globally. Also in Italy, OA is a widespread and debilitating disease that affects a growing segment of the population. OA generally develops over the course of decades, providing a long window of time to potentially influence its natural history. The etiology of osteoarthritis is multifactorial and shows strong associations with modifiable risk factors such as mechanical overload and obesity. With the increase in obesity and the age of the population there is expected to be a massive increase in Italy in morbidity and costs attributable to OA. The characterisation of pre-arthritic disease states will be crucial to support a paradigm shift from symptomatic treatment of the disease in the late stage towards primary and secondary prevention. The diagnosis and treatment strategies in early OA may reduce both the morbidity of the patient and the relevant costs, but the lack of a clear definition and characterisation of pre-radiographic OA still impedes its implementation.

The innovative feature of the project

We need to define and recognise the initial symptomatic states of OA; the data of the literature in this field are extremely scarce. In recent years, cohort studies have been made to study the natural history of osteoarthritis – in the USA and northern Europe, the "OARSI Initiative" and the "CHECK" study, respectively. However, currently there is no definition of early stage osteoarthritis, so it is not possible to study the earliest stages of the disease if not as subjects at risk of developing late phases.

The originality of the programme lies in its being based on the study of the early stages of the disease, still sensitive to a potential 'disease-modifying' intervention, and is divided into several phases. The ESORT register is Phase 2 of the research programme.


General objectives

  • Phase 1 (Qualitative Research): Define the early symptomatic OA.
  • Phase 2 (ESORT Register): Study the natural history of OA right from the earliest stages (pre-radiographic) disease and to study the risk factors for progression and influence of therapeutic factors on long-term disease outcome.
  • Phase 3 (ESORT Study): Promote, design, coordinate and conduct an international cohort study on early OA.


Descriptive objectives

  • Describe the socio-demographic and clinical characteristics of patients with OA in Italy.
  • Assess the extent of symptoms, functional impairment and comorbidity in the Italian patient population.
  • Analyse the frequency of use of currently available drugs, evaluating the differences in relation to the clinical subset, comorbidities and geographical location of the patient.

Cross-sectional objectives

  • For the different forms of arthritis, identify the socio-demographic, clinical and therapeutic features that are associated with pain, disability and damage.

Longitudinal objectives

  • In patients with early symptomatic OA of the knee, identify the socio-demographic characteristics and medical history (including lifestyles) that are associated with progression to established forms of OA.
  • Identify the socio-demographic, clinical and therapeutic features that are associated with pain, disability and damage.