The pathological mechanism of Kashin-Beck disease (KBD), an endemic osteoarthritic disease, remains to be poorly understood. This study was designed to identify signaling pathways and crucial proteins involved in the pathological mechanism of KBD compared with osteoarthritis (OA). The knee cartilage samples were collected from gender-and age-matched KBD (n = 9) and OA (n = 9) patients. After preprocessing, samples were labeled with Tamdem Mass Tags 6plex multiplex kit, and analyzed by liquid chromatography-tandem mass spectrometry. Proteomic results were analyzed with gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interactions (PPI). The differential abundance proteins from KBD and OA were validated using western blot analysis. As a result, A total number of 375 proteins were identified to have differential abundance between KBD and OA, of which 121 and 254 proteins were observed to be up-regulated or down-regulated in KBD group. GO analysis shows that the differential abundant proteins are associated with cell junction and signal transducer activity from extracellular to intracellular. KEGG pathways enrichment and PPI network indicate four major pathways, including extracellular matrix -receptor interaction, focal adhesion, phosphatidylinositol 3-kinase (PI3K)-Protein kinase B (Akt), and Ras signaling pathways were involved in the degeneration of cartilage. Moreover, integrins, laminins, NF-κB and other regulative molecules were found as crucial proteins. In conclusion, our results demonstrated that compared with OA, the differential abundance proteins and signaling pathways may contribute to the occurrence and development of joint damage in KBD. Further investigation of their regulative roles and interaction may provide new insights into the pathological mechanisms and therapeutic targets for KBD.Osteoarthritis (OA) is a progressive, degenerative joint disease. It is the major cause of knee pain and locomotor disability worldwide 1,2 . The WHO Scientific Groupon Rheumatic Diseases estimates that 10% of the world's population who are 60 years or older have significant clinical problems attributed to OA 3 . Unlike OA, Kashin-Beck disease (KBD) is a chronic and serious endemic osteoarticular disease, which has been in high prevalence and morbidity in Eastern Siberia of Russia, Northeast China to Sichuan-Tibet Plateau, and North Korea 4,5 . According to the statistics, there were 1.04 billion people in risk of KBD and 0.57 million patients with KBD in China 6 . However, the etiology and pathological mechanisms of KBD are still waiting to be uncovered 7 , which lessen the chances of further effective prevention and treatment measures for the current KBD patients.