SeminarOsteoarthritis
Section snippets
Epidemiology
A single definition of osteoarthritis remains elusive. A workshop held in 1995 proposed the following consensus definition: “Osteoarthritic diseases are a result of both mechanical and biologic events that destabilize the normal coupling of degradation and synthesis of articular cartilage chondrocytes and extracellular matrix, and subchondral bone. Although they may be initiated by multiple factors, including genetic, developmental, metabolic, and traumatic, osteoarthritis diseases involve all
Pathogenesis
Osteoarthritis is generally seen as a disease of articular cartilage although it is clear that changes in subchondral bone are also important. Indeed, in idiopathic osteoarthritis, it remains unknown whether the initial abnormality occurs in the articular cartilage or the subchondral bone.
Articular cartilage has two main functions: absorbing stress by deforming under mechanical load and providing a smooth load bearing surface to permit low-friction movement of the joint. The functional
Clinical features
The clinical features of osteoarthritis are summarised in panel 3. Pain is the most important symptom which brings the patient to the doctor's surgery; it is usually insidious in onset, mild-to-moderate in intensity, worsened by use of the involved joint, and improved with rest. Pain at rest or during the night are features of severe disease. Possible sources and causes of pain in patients with osteoarthritis include the synovial membrane, joint capsule, periarticular ligaments, periarticular
Management
Current treatment of osteoarthritis is purely to control symptoms because as yet there are no disease-modifying osteoarthritis drugs. The principal measure of treatment efficacy is traditionally pain, though other outcomes, such as functional limitation and reduced quality of life may also be included in trials.29 Systematic reviews of both non-pharmacological33 and pharmacological therapy of lower-limb osteoarthritis,34, 35 as well as guidelines for the management of lower-limb osteoarthritis,
Future
The understanding of the osteoarthritic disorders has increased over the past decade. The development of selective cyclooxygenase-2 inhibitors may provide safer NSAIDs which will improve the management of symptoms in patients with osteoarthritis.46, 47 Studies of several novel agents, including chemically modified tetracyclines and other metalloproteinase inhibitors, and IL-1 receptor antagonists have the potential to reverse the structural or biochemical abnormalities of osteoarthritis are
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