Etiopathogenesis of Osteoarthritis
Section snippets
Current definitions of osteoarthritis
At a 1986 workshop on the etiopathogenesis of osteoarthritis (OA) sponsored by the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases, the National Institute on Aging, the American Academy of Orthopaedic Surgeons, the National Arthritis Advisory Board and the Arthritis Foundation, OA was defined comprehensively [1]:
Clinically, the disease is characterized by joint pain, tenderness, limitation of movement, crepitus, occasional effusion, and variable degrees of local
A current view of the etiopathogenesis of osteoarthritis
In the definitions given in the previous section, the emphasis is on joint damage in general and on loss of articular cartilage in particular. In contrast, the authors view OA as a process that is attempting to contain a mechanical problem in the joint. OA is best defined as failed repair of damage that has been caused by excessive mechanical stress (defined as force/unit area) on joint tissues. Because the body's innate mechanisms for repairing the damaged tissues cannot be effective in the
Articular cartilage healing and remodeling: mechanobiology of the chondrocyte
The remodeling of connective tissues requires removal of damaged matrix to allow for its replacement. Inflammation and alterations of cell metabolism are an essential part of this healing process. In a normal joint, chondrocytes in the articular cartilage are subjected to physiologic dynamic and static compressive and deep shear stresses. When explants of normal articular cartilage were subjected to noninjurious loading (ie, loading that did not result in loss of cartilage matrix molecules into
Why does any of this matter? Lack of relevance of chondroprotective drugs to the underlying process
Understanding the etiopathogenesis of OA matters because of the implications for treatment of patients. Because the synovial inflammation in OA is secondary to mechanical damage to the cartilage and bone, it stands to reason that nonsteroidal anti-inflammatory drugs (NSAIDs), although they may be effective symptomatically, cannot arrest the process. Efforts to develop disease-modifying OA drugs (which formerly were called “chondroprotective drugs” and now also are called “structure-modifying OA
Why doesn't everyone develop progressive osteoarthritis? Mechanisms protecting the joint from microdamage
In normal walking, three to four times the weight of the body is transmitted through the knee; during a deep knee bend, the patellofemoral joint is subjected to a load 9 to 10 times body weight. Adaptive mechanisms must protect the joint from these physiologic loads. Although the bulk properties of articular cartilage would make it an excellent shock absorber, at most sites it is too thin to serve as an adequate shock-absorbing structure in a joint. The periarticular muscles and subchondral
Etiopathogenesis of osteoarthritis pain
For the patient and clinician, the essential problem associated with OA is joint pain. Indeed, if OA were not painful, it would receive little attention. Liang [59] succinctly captured the issue: “[X]-rays don't weep.” Patients weep.
The following discussion places that statement into context. Among people who have OA, those who have more severe radiographic changes are somewhat more likely to have difficulty with mobility, but the radiographic progression of OA usually is slow, and the course
Relief of osteoarthritic pain by physiologic interventions: further reasons to consider a mechanical etiopathogenesis of osteoarthritis
In considering risk factors for OA from an epidemiologic perspective, Felson [91] suggested that elimination of obesity, prevention of knee injury, and elimination of jobs requiring knee bending and carrying heavy loads, all of which can cause increased stress on the joints under consideration, would decrease the incidence of OA of the hip and knee significantly. The authors of this article contend that such considerations may be important both in the prevention of incident OA and in the
Summary
The importance of abnormal joint mechanics in the etiopathogenesis of OA cannot be overemphasized. The authors view OA as a process that is attempting to contain a mechanical problem in the joint; OA is best defined as failed repair of joint damage that has been caused by excessive mechanical stress. Because the body's innate mechanisms for repairing damaged cartilage cannot deal with the underlying mechanical abnormality, they cannot solve the problem of OA. Remodeling of the subchondral bone
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2022, HeliyonCitation Excerpt :A better understanding of the molecular mechanisms underlying OA would facilitate the development of alternative biological approaches to slow disease progression. An imbalance of homeostasis between the synthesis and degradation of cartilage has been proposed as a central etiological mechanism underlying OA [1]. According to the most recent evidence, the synovial membrane, the joint capsule, ligaments, muscles and the infrapatellar fat pad contribute to the progression of early OA [3, 4].
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Some of the thoughts expressed in this article are contained in a chapter, “Neuromuscular Aspects of Osteoarthritis,” written by KDB, that is to be published by Wiley-Blackwell in the book, Osteoarthritis Pain, edited by D.T. Felson and H-G. Schaible.