Developments in the clinical understanding of osteoarthritis

Abstract

With the recognition that osteoarthritis is a disease of the whole joint, attention has focused increasingly on features in the joint environment which cause ongoing joint damage and are likely sources of pain. This article reviews current ways of assessing osteoarthritis progression and what factors potentiate it, structural abnormalities that probably produce pain, new understandings of the genetics of osteoarthritis, and evaluations of new and old treatments.

Osteoarthritis in horses - Part 1: relationship between clinical and radiographic examination for the diagnosis

“…The origin of the pain is not in the cartilage because its anatomical structure has no nociceptive fibers. According to Felson (2009), these fibers are found in the synovium, periosteum, subchondral bone and articular capsule and in the meniscus of the stifle joint and the marrow of long bones. Raffa (2003) reported that mechanical and chemical stimuli (resulting from inflammation of the tissue) are responsible for pain originating in synovial joints.…”

Osteoarthritis: etiology, epidemiology, impact on the individual and society and the main principles of management

“…It is primarily a disease of the cartilage that ultimately leads to a local tissue response, usually consisting of infl ammation, and consequently to mechanical changes that culminate in the failure of these structures to function normally; therefore, the entire joint organ, including the subchondral bone, menisci, ligaments, periarticular muscle, capsule, and synovium is involved in pathological process (2,6). Radiographically, OA is characterized by joint space narrowing, osteophytosis, subchondral sclerosis, cyst formation, and abnormal bone contours (7).…”

“…Although morning stiffness reduces with the use of the joints, mostly patients with OA appear to acquire more symptoms as the day progresses. Thus, pain increases as the joints are required to bear weight or perform activities throughout the day (6). The data of the AMI-CA study, Italy, revealed that the most painful OA joints were the knee in 12 827 patients (54%), the hip in 5645 patients (24%), and the hand in 5467 patients (23%) -percentages calculated on the 23 939 patients for whom this information was available (26).…”

“…The joints most commonly involved in the pathological process are knees, hips, feet, ankles, the distal and proximal interphalangeal joints, the fi rst carpometacarpal joints, and low spine. It is unusual for the wrists, elbows, or shoulders to be involved in pathogenic process (6).…”

Defining the Content of an Opportunistic Osteoarthritis Consultation With Primary Health Care Professionals: A Delphi Consensus Study

“…Osteoarthritis (OA) is the most common cause of joint pain in older adults (1) and is one of the top 10 causes of years lived with disability (2). Despite this and the publication of international treatment recommendations (3)(4)(5), evidence suggests that in the UK, there is a gap between the care recommended and that which people receive (6,7).…”