Assessing macroscopic and microscopic indicators of osteoarthritis in the distal interphalangeal joints: A cadaveric study

Abstract

Osteoarthritis is manifested both by macroscopically visible lesions and by specific histological indicators. Although traditional views of the disease process invoke physical abrasion of joint surfaces, recent studies indicate that tissue-level changes may precede grossly visible lesions of articular cartilage. This study investigates the association between gross and histological indicators of osteoarthritis at the manual interphalangeal joints, and examines a sequence of events that may lead to the onset of cartilage degeneration. Interphalangeal joints from the hands of nine cadavers were dissected, of which 52 joints were collected and further evaluated. Gross degradation of the proximal articular surface was graded on a scale of 0-3 (with 0 representing normal cartilage with no visible lesions). Osteoarthritic lesions were found in 86% of specimens and showed no preferential occurrence between males and females or right and left hands. Histological analysis indicated that known microscopic indicators of osteoarthritis always occur in Grade 1-3 specimens, but can also be recognized in some macroscopically normal specimens. Many macroscopically normal specimens exhibited chondrocyte clustering (28.6%) and/or tide mark irregularities (57%), indicating that these features are most likely the earliest to develop in the progression of osteoarthritis. It is possible that the initiating etiology is thickening of the subchondral bone, but this was not directly observed. Results indicate significant thinning of the cartilage as macroscopic degradation progresses. Our study supports, with slight modification, a previously proposed cascade of histological changes that may ultimately lead to the physical destruction of articular cartilage.

Osteoarthritis of the Distal Interphalangeal Joint

“…58 The histology of Heberden's nodes remains unclear, and a variety of pathologies have been described, including the presence of bony outgrowths that are consistent with osteophytosis, cartilage hypertrophy, or even mucoid transformation of the periarticular fibroadipose tissue associated with proliferation of myxoid fibroblasts and cyst formation. 10,58,62 However, only a weak correlation of Heberden's nodes and DIP osteophytes has been shown recently. 58…”

“…9,45,64,65 For the DIP joint, histological analysis has shown that cartilage fibrillation, tide mark irregularities, and chondrocyte clustering are early microscopic indicators of DIP joint OA and are clearly linked to, and largely precede, the macroscopic degradation of the articular surface. 10 A magnetic resonance imaging (MRI) study demonstrated articular cartilage destruction, albeit variable, to have an ulnar as well as volar predilection. 57 Subchondral bone sclerosis, seen as low signal change in the subchondral bone on all sequences, was evident on the distal side of the DIP joints in 56% with early OA and 93% with chronic OA.…”

The role of the elastic fiber system in the pathogenesis of osteoarthritis and knee joint laxity

“…Both studies utilized clinical and radiographic signs to determine the severity of OA. This may be of particular importance because recent evidence suggests that histological markers can precede both clinical and radiographic evidence of OA (Agha and Webb 2006;Bentley and Hill 2007). In addition, although each study used slightly different methods for evaluating joint laxity, neither used the elastic fiber concentration of the knee joint capsule.…”

“…Specifically, we test the hypothesis that the concentration of elastic fibers per unit area is related to OA grade, based on macroscopic and histological observations. Histological analysis is included since recent evidence suggests that histological markers can predate both clinical and radiographic evidence of OA (Agha and Webb 2006;Bentley and Hill 2007). Using histological markers, we anticipate that the relationship can be evaluated at the earliest possible signs of OA.…”

Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella

“…However, the disease process may be quite advanced at the histological level before any macroscopic changes become visible (Agha and Webb 2006, Bentley and Hill 2007). …”