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Background

This very common condition is more commonly, and inappropriately, known as osteoarthritis. It is a degenerative condition that can affect all ages and both sexes.

OUTLINE

Epidemiology  
Disease Associations  
Pathogenesis  
Laboratory/Radiologic/
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Gross Appearance and Clinical Variants  
Histopathological Features and Variants  
Special Stains/
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Differential Diagnosis  
Prognosis  
Treatment  
Commonly Used Terms  
Internet Links  

 

EPIDEMIOLOGY CHARACTERIZATION
SYNONYMS  
INCIDENCE/
PREVALENCE
 
AGE  
SEX  
GEOGRAPHY  
Racial and ethnic differences in osteoarthritis: prevalence, outcomes, and medical care.

Dominick KL, Baker TA.

Health Services Research and Development Service, Durham VAMC and the Department of Medicine, Duke University Medical Center, Durham, North Carolina 27713, USA.

Ethn Dis. 2004 Autumn;14(4):558-66. Abstract quote  

Osteoarthritis (OA) is the most common chronic condition and a leading cause of disability among older adults. Studies indicate there are important racial and ethnic differences in the prevalence of OA, as well as in the associated outcomes and medical care.

In general, research suggests some minority groups, especially African-American and Hispanic individuals, may be at risk for poorer outcomes (such as pain and disability), and are less likely to undergo arthroplasty, compared to Caucasian Americans.

Racial and ethnic differences in OA and its medical care are poorly understood. Research is needed to examine biological, psychosocial, and lifestyle factors that may contribute to these disparities.

 

DISEASE ASSOCIATIONS CHARACTERIZATION
HEMODIALYSIS  
Osteoarthritis in hemodialysis patients: relationships with bone mineral density and other clinical and laboratory parameters.

Kart-Koseoglu H, Yucel AE, Niron EA, Koseoglu H, Isiklar I, Ozdemir FN.

Rheumatology Division, Baskent University Faculty of Medicine, Fevzi cakmak cad. 10.sok, Bahcelievler, Ankara, Turkey 06490
Rheumatol Int. 2005 May;25(4):270-5. Epub 2004 Mar 4. Abstract quote  

OBJECTIVE: The aim of this study was to determine the role that hemodialysis (HD) plays in radiologically assessed osteoarthritis (OA) of the hand, knee, and hip.

MATERIALS AND METHODS: Eighty patients who had been on regular HD for at least 2 years were included. Anterior-posterior radiographs of the pelvis, weight-bearing knees, and hands and wrists of each patient were examined. Bone mineral density (BMD) of spine, femur, and forearm was measured.

RESULTS: Radiologic assessment of the 80 patients' hands showed that 41 individuals had osteopenia, 12 had midphalangeal subperiosteal resorption, 11 had cystic bone lesions, eight had bone erosion, four had osteophytic lesions, and three had subchondral sclerosis. Bone erosion in the hands was significantly associated with HD duration, forearm T score, and serum parathyroid hormone level. Radiologically, OA was demonstrated in eight knee and ten hip joints. Minimum joint space in the tibiofemoral compartment correlated with body mass index, and minimum joint space in the hip correlated with age. The mean BMD measurements at all three sites studied in the HD patients were low. Only the duration of HD significantly correlated with forearm BMD.

CONCLUSION: Osteoarticular complications are common in HD patients.

 

PATHOGENESIS CHARACTERIZATION
APOPTOSIS  
Polyamine depletion inhibits apoptosis following blocking of survival pathways in human chondrocytes stimulated by tumor necrosis factor-alpha.

Stanic I, Facchini A, Borzi RM, Vitellozzi R, Stefanelli C, Goldring MB, Guarnieri C, Facchini A, Flamigni F.

Dipartimento di Biochimica "G. Moruzzi", University of Bologna, Bologna, Italy.
J Cell Physiol. 2005 Jun 17; [Epub ahead of print] Abstract quote  

Chondrocyte apoptosis can be an important contributor to cartilage degeneration, thereby making it a potential therapeutic target in articular diseases.

To search for new approaches to limit chondrocytic cell death, we investigated the requirement of polyamines for apoptosis favored by tumor necrosis factor-alpha (TNF), using specific polyamine biosynthesis inhibitors in human chondrocytes. The combined treatment of C-28/I2 chondrocytes with TNF and cycloheximide (CHX) resulted in a prompt effector caspase activation and internucleosomal DNA fragmentation.

Pre-treatment of chondrocytes with alpha-difluoromethylornithine (DFMO), an ornithine decarboxylase (ODC) inhibitor, markedly reduced putrescine and spermidine content as well as the caspase-3 activation and DNA fragmentation induced by TNF and CHX. DFMO treatment also inhibited the increase in effector caspase activity provoked by TNF plus MG132, a proteasome inhibitor. DFMO decreased caspase-8 activity and procaspase-8 content, an apical caspase essential for TNF-induced apoptosis. Although DFMO increased the amount of active, phosphorylated Akt, inhibitors of the Akt pathway failed to restore the TNF-induced increase in caspase activity blunted by DFMO. DFMO also reduced the increase in caspase activity induced by staurosporine, but in this case Akt inhibition prevented the DFMO effect.

Pre-treatment with CGP 48664, an S-adenosylmethionine decarboxylase (SAMDC) inhibitor markedly reduced spermidine and spermine levels, and provoked effects similar to those caused by DFMO. Finally DFMO was effective even in primary osteoarthritis (OA) chondrocyte cultures.

These results suggest that the intracellular depletion of polyamines in chondrocytes can inhibit both the death receptor pathway by reducing the level of procaspase-8, and the apoptotic mitochondrial pathway by activating Akt.

 

LABORATORY/
RADIOLOGIC/
OTHER TESTS

CHARACTERIZATION
RADIOLOGIC  
The distribution and inter-relationships of radiologic features of osteoarthrosis of the hip. A survey of 4151 subjects of the Copenhagen City Heart Study: the Osteoarthrosis Substudy.

Jacobsen S, Sonne-Holm S, Soballe K, Gebuhr P, Lund B.

Department of Orthopaedic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.

Osteoarthritis Cartilage. 2004 Sep;12(9):704-10. Abstract quote  

OBJECTIVE: The aims of this study were to investigate the influence of sex, age and individual physical and occupational factors on the distribution of radiographic features of hip joint osteoarthritis (OA), and to determine the inter-relationships between the primary radiographic OA discriminator of reduced joint space width (JSW), and secondary radiographic OA features.

METHOD: The study was a cross-sectional survey. Radiologic features of hip OA were recorded from standardized, standing pelvic radiographs of 3686 subjects (1397M/2289F). OA features were investigated for inter-relationships and correlations to age, sex, body mass index (BMI) and occupational exposure to repeated lifting.

RESULTS: Overall, subchondral sclerosis, cysts and osteophytes were more frequently recorded in male hip joints compared to female hip joints, while a decrease in minimum JSW by age was more pronounced and progressive in women after the fifth decade compared to men. Applying logistic regression analyses, only age was found to be significantly associated to pathologically reduced minimum JSW (cut off value set at < or =2.0 mm), and the presence of osteophytes and subchondral cysts in both sexes (P ranging from 0.00 to 0.03). Minimum JSW < or =2.0 mm was recorded in 105 male hip joints, and in 167 female hip joints. In these joints, subchondral cysts, osteophytes and sclerosis were found to be significantly inter-related to minimum JSW < or =2.0 mm according to logistic regression analysis. The presence of subchondral cysts had the highest predictive sensitivity in regard to pathologically reduced minimum JSW compared to subchondral sclerosis and osteophytes.

CONCLUSIONS: We believe that an accurate radiologic case definition of hip OA will rest on a combination of features. Only studies of the distribution of features, singularly and in combination, applied to clinically evaluated large cohorts may provide the optimum answer to the best possible clinical case definition of hip OA.
LABORATORY MARKERS  
GENERAL  
Biomarkers in osteoarthritis.

Garnero P, Delmas PD.

INSERM Research Unit 403, Lyon, France.
Curr Opin Rheumatol. 2003 Sep;15(5):641-6. Abstract quote  

PURPOSE OF REVIEW: Osteoarthritis is a chronic disease characterized by progressive destruction of articular cartilage and subchondral bone, and synovial reaction. Clinical and radiologic findings that form the basis of the diagnosis of osteoarthritis are poorly sensitive for monitoring the progression of the disease. Biologic markers reflecting quantitative and dynamic changes of joint tissue turnover represent promising adjunct tools.

RECENT FINDINGS: New tissue-specific markers have been developed and include assays for type II collagen synthesis and degradation and synovitis. Prospective studies indicate that increased or decreased levels of some of these markers are associated with rapid progression of joint destruction in patients with knee osteoarthritis. Because progression of joint damage is likely to result primarily from an imbalance between degradation and reparative processes, a combination of markers reflecting these two components appears promising. For example, combining two new markers for type II collagen synthesis and degradation in an uncoupling index of cartilage turnover was more effective in predicting 1-year radiologic progression in knee osteoarthritis than the measurement of a single marker. Preliminary data in rheumatoid arthritis show a rapid response of a marker of type II collagen degradation under disease-modifying antirheumatic drugs, with early changes of this marker being predictive of long-term radiologic progression.

SUMMARY: Recent evidence suggests that the combination of some biologic markers will be useful for identifying patients at risk for rapid joint destruction in osteoarthritis. Because of their rapid changes under treatment, biologic markers will play an important role in the development and monitoring of new structure-modifying therapies for osteoarthritis.
URINE  
Identification of an urinary metabolite profile associated with osteoarthritis.

Lamers RJ, van Nesselrooij JH, Kraus VB, Jordan JM, Renner JB, Dragomir AD, Luta G, van der Greef J, Degroot J.

TNO Quality of Life & TNO Pharma, PO Box 360, 3700 AJ Zeist, The Netherlands.
Osteoarthritis Cartilage. 2005 Jun 9; [Epub ahead of print] Abstract quote  

OBJECTIVE: Osteoarthritis (OA) is one of the most common diseases among the elderly. The main characteristic is the progressive destruction of articular cartilage. We lack quantitative and sensitive biomarkers for OA to detect changes in the joints in an early stage of the disease. In this study, we investigated whether a urinary metabolite profile could be found that could serve as a diagnostic biomarker for OA in humans. We also compared the profile we obtained previously in the guinea pig spontaneous OA model.

METHODS: Urine samples of 92 participants (47 non-OA controls and 45 individuals with radiographic OA of the knees or hips) were selected from the Johnston County Osteoarthritis Project (North Carolina, USA). Participants ranged in age from 60 to 84 years. Samples were measured by (1)H nuclear magnetic resonance spectroscopy (NMR) with subsequent principal component discriminant analysis and partial least squares regression analysis.

RESULTS: Differences were observed between urine NMR spectra of OA cases and controls (P<0.001 for both male and female subjects). A metabolite profile could be determined which was strongly associated with OA. This profile largely resembled the profile previously identified for guinea pigs with OA ( approximately 40 out of the approximately 125 signals of the human profile were present in the guinea pig profile as well). A correlation was found between the metabolite profile and radiographic OA severity (R(2)=0.82 (male); R(2)=0.93 (female)).

CONCLUSION: This study showed that a urine metabolite profile may serve as a novel discriminating biomarker of OA.

 

GROSS APPEARANCE/
CLINICAL VARIANTS
CHARACTERIZATION
GENERAL  
VARIANTS  

 

HISTOLOGICAL TYPES CHARACTERIZATION
GENERAL  
SPINE  
Degenerative spine disease : pathologic findings in 985 surgical specimens.

Pytel P, Wollmann RL, Fessler RG, Krausz TN, Montag AG.

Department of Pathology, Section of Neurosurgery, University of Chicago Hospitals, Chicago, IL.


Am J Clin Pathol. 2006 Feb;125(2):1-10. Abstract quote  

A number of pathologic changes have been reported in spinal surgery specimens. The frequency of many of these is not well defined.

We retrospectively reviewed the histologic features of 985 extradural spinal surgery specimens. Of the cases, 1.6% were identified clinically as synovial cysts. In addition, synovial tissue was seen in another 5.3% of cases, often embedded within disk material. Neovascularization of disk tissue was present in 8.1% of cases, chondrocyte clusters in 18.3%, and calcium pyrophosphate crystals in 2.8%, predominantly within disk material. With the exception of crystal deposits, all of these changes were significantly more common in the lumbar spine. A better understanding of cell-based degenerative changes will become essential with increasing research into cell-based therapies for spinal disk disease.

We report data on the frequency of different pathologic changes and describe synovial metaplasia as a reactive change not previously reported.

 

SPECIAL STAINS/
IMMUNOPEROXIDASE/
OTHER
CHARACTERIZATION
SPECIAL STAINS  
IMMUNOPEROXIDASE  
ELECTRON MICROSCOPY  

 

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES

 

PROGNOSIS CHARACTERIZATION
WOMAC  
Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index.

Tuzun EH, Eker L, Aytar A, Daskapan A, Bayramoglu M.

Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Ankara, Turkey.
Osteoarthritis Cartilage. 2005 Jan;13(1):28-33. Abstract quote  

OBJECTIVE: To evaluate the acceptability, reliability, validity and responsiveness of the Turkish version of Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index in physiotherapy outpatient practice in Turkey.

METHOD: Data were obtained from 72 patients with OA of the knee. They were asked to answer two disease-specific questionnaires (WOMAC LK 3.1 and Lequesne-Algofunctional Index of Severity for the knee) and one generic instrument (Medical Outcomes study SF-36 Survey-SF-36). Acceptability was assessed in terms of refusal rate, rates of missing responses, and administration time. Reliability was assessed using Cronbach's alpha. Content validity was assessed by examining the floor and ceiling effects, and skew of the distributions. Convergent and divergent validity was assessed by examining the Pearson's correlation coefficients. Responsiveness was determined by examining effect size (ES), standardized response means (SRM) and P values generated using Wilcoxon's test.

RESULTS: The overall response rate was 100%. Alpha values for all WOMAC subscales exceeded the value of 0.70 at both baseline and follow-up assessments. Frequency distributions of scores were symmetrical. Subscales had negligible floor and ceiling effects. Both pain and physical function subscales were fairly correlated with the subscales measuring similar constructs of SF-36, whereas they were weakly correlated with other dimensions of SF-36. A good correlation was obtained between WOMAC total and Lequesne index. The pain and physical function subscales of WOMAC index were the most responsive subscales.

CONCLUSION: The Turkish WOMAC OA index is acceptable, valid, reliable and responsive for use in Turkish patients with knee OA.
Superior responsiveness of the pain and function sections of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) as compared to the Lequesne-Algofunctional Index in patients with osteoarthritis of the lower extremities.

Theiler R, Sangha O, Schaeren S, Michel BA, Tyndall A, Dick W, Stucki G.

The Clinic of Rheumatology, Aarau General Hospital, Aarau, Switzerland.

Osteoarthritis Cartilage. 1999 Nov;7(6):515-9. Abstract quote  

OBJECTIVE: To compare the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a questionnaire format of the Lequesne-Algofunctional Index in patients with OA of the lower extremities.

METHODS: Longitudinal analysis of the instruments' responsiveness [standardized response mean (SRM), effect size (ES)] in ambulatory patients undergoing hip or knee arthroplasty. RESULTS: At six months 36, and at one year 40 out of 43 patients undergoing hip (N=30) or knee arthroplasty (N=13) could be examined. Both responsiveness statistics revealed the same order of responsiveness. For both indices and for both locations, the pain sections were more responsive than the function sections. However, the WOMAC scales and the WOMAC global index (hip at 12 months: SRM=2.4; knee at 12 months: SRM=2.0 ) were more responsive than the comparable Lequesne sections and Lequesne index (hip at 12 months: SRM=2.1; knee at 12 months: SRM=1.5). CONCLUSIONS: Although our results are based on a German version using a self-report format, the WOMAC scales appear to be more responsive than the Lequesne index in patients with OA of the lower extremities.

 

TREATMENT CHARACTERIZATION
GENERAL  
Advancements in the surgical and alternative treatment of arthritis.

Lyman S, Sherman S, Dunn WR, Marx RG.

Foster Center for Clinical Outcome Research, Hospital for Special Surgery, New York, New York 10021, USA.
Curr Opin Rheumatol. 2005 Mar;17(2):129-33. Abstract quote  

PURPOSE OF REVIEW: Surgical and nonsurgical treatment of arthritis is a rapidly developing and evolving field. It is vital for clinicians to keep up on the latest advances. This review focuses on clinical trials or large prospective studies over the past year that evaluated orthopedic surgical techniques for the treatment of arthritis and new nonsurgical therapies that may prevent the need for surgical intervention. Increasing attention has also been focused on the relation between surgeon or hospital case load and the quality of outcomes after surgery.

RECENT FINDINGS: No fewer than 10 studies have been published over the past year evaluating the use of hyaluronic acid (a visco-supplement) or corticosteroid injections as alternative treatments to knee arthroscopy for osteoarthritis of the knee. Joint replacement research has explored minimally invasive and computer-guided or robot-guided joint replacement surgery, the best operative choice for advanced shoulder arthritis (hemiarthroplasty compared with total shoulder replacement), the role of patellar resurfacing during total joint replacement, and the use of bisphosphonates for retention of bone density after joint replacement.

SUMMARY: The increasing attention on high-quality surgical trials should continue to improve surgical options based on sound research for patients with arthritis. Future research should continue to improve the available high-quality research for treatment choices.
HYALURON  
A prospective randomised controlled clinical trial comparing the efficacy of different molecular weight hyaluronan solutions in the treatment of knee osteoarthritis.

Kotevoglu N, Iyibozkurt PC, Hiz O, Toktas H, Kuran B.

Physical Therapy and Rehabilitation Department, Sisli Etfal Teaching Hospital, Bagdat Cad. No: 78 da: 1 Kiziltoprak, Istanbul, 81030, Turkey
Rheumatol Int. 2005 Jun 15; [Epub ahead of print] Abstract quote  

Viscosupplementation consists of injecting exagenous hyaluronan (HA) into the synovial joints to restore the normal rheological environment which deteriorates severely in osteoarthritic (OA) joints. Efficacy might be related to the rheological properties and molecular weight (MW) of the hyaluronan preparations.

This prospective, controlled, double-blind, randomised clinical trial was aimed at comparing the elastoviscous properties of a high molecular weight viscosupplement, hylan G-F 20, with that of a lower molecular weight hyaluronan product in order to determine the relationship of elastoviscosity to efficacy, alongside placebo, in the treatment of patients with knee OA. The results were analysed as a "completers" analysis with 59 patients. Primary outcome measures included the Western Ontario and Mc Master Universities' Osteoarthritis Index (WOMAC) for pain, stiffness and function scores, and patient and physician global assessments (0-100 scale). For patient (PGA) and physician global assessments (PhGA), the 0-100 scale was used, with 100 being the worst. Follow-up assessments were made at intervals of 1, 3 and 6 months after the first injection. Local adverse events, such as transient pain at the injection site or warm knee lasting for one night, were recorded in two patients (3%).

In all groups, the WOMAC pain score exhibited a significant difference from the baseline value; neither treatment group was significantly different from the placebo group, but total pain score was significantly better than baseline for both of the HA groups at the end of 6 months (p < 0.05). Improvement in WOMAC physical function score favoured both sodium hyaluronate and hylan G-F 20 after the first month, and remained significant until the end of 6 months (p < 0.01). In the placebo group, the physical function scores became worse after the end of the 1st month; the scores at the end of 6 months were no different from those at the beginning. The WOMAC stiffness scores of both of the hyaluronic acid groups improved with the first injection, and remained significantly better than the placebo group until the end of the survey (p < 0.001). All groups expressed improvement with PGA scores after the first injection. At the end of 6 months all three groups were similar, but the treatment groups were significantly better than the placebo group (p < 0.05), and all were significantly better than at the beginning (p < 0.05). The PhGA scores were similar in all groups until after the third injection. The second group was slightly better in the controls at 1 and 3 months, but all the groups were similar at the end of 6 months. Although the placebo group seemed worse, it was not statistically significant.

Compared with lower molecular weight HA, the higher molecular weight HA might be more efficacious in treating knee OA, but heterogeneity of previous studies limited definitive conclusions. Patients treated by injection of either of two hyaluronan preparations showed clinical improvement for pain, though no different from the placebo group; WOMAC stiffness scores were better than placebo in the HA groups, whereas PGA scores showed improvement in all groups but HA groups were better than placebo. PhGA scores were worse in the placebo group, but not to a statistically-significant extent. The HA groups did not differ in terms of clinical efficacy.
 
Effectiveness and safety of repeat courses of hylan G-F 20 in patients with knee osteoarthritis.

Raynauld JP, Goldsmith CH, Bellamy N, Torrance GW, Polisson R, Belovich D, Pericak D, Tugwell P.

Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
Osteoarthritis Cartilage. 2005 Feb;13(2):111-9. Abstract quote  

OBJECTIVE: To compare the effectiveness and safety of repeat treatment with hylan G-F 20 based on data from a randomized, controlled trial [Raynauld JP, Torrance GW, Band PA, Goldsmith CH, Tugwell P, Walker V, et al. A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 1 of 2): clinical results. Osteoarthritis Cartilage 2002;10:506-17]. The hypotheses tested were whether the single-course and repeat-course subgroups would be superior to appropriate care and not different from each other.

METHOD: A total of 255 patients with knee osteoarthritis were randomized to "appropriate care with hylan G-F 20" or "appropriate care without hylan G-F 20". The hylan G-F 20 group was partitioned into two subgroups: (1) patients who received a single course of hylan G-F 20; and (2) patients who received two or more courses of hylan G-F 20.

RESULTS: For the primary effectiveness measure, change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score as a percent of baseline, the single-course subgroup improved by 41%, the repeat-course subgroup by 35%, and the appropriate care group by 14%. Both subgroups improved significantly more than the appropriate care group (P<0.05), and were not statistically significantly different from each other (70% power to detect a 20% difference). Secondary effectiveness measures showed similar results. In the repeat-course subgroup, no statistically significant differences were found in the number of local adverse events, the number of patients with local adverse events, or arthrocentesis rates between the first and repeat courses of treatment.

CONCLUSIONS: Although the study was neither designed nor powered to examine repeat treatment, this a posteriori analysis provides support for a favorable effectiveness and safety profile of hylan G-F 20 in repeat course patients.
SURGERY  
Long-term results and arthropathy following the modified Bristow-Latarjet procedure.

Spoor AB, de Waal Malefijt J.

Department of Orthopaedic Surgery, Sint Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands,
Int Orthop. 2005 Jun 14; [Epub ahead of print] Abstract quote  

The incidence of early osteoarthritis after the modified Bristow procedure has been the subject of several articles during the last decade. Recurrent dislocation, recurrent subluxation after surgery or the procedure itself have been suggested as the main causes of degenerative changes.

We assessed 19 patients who underwent the Bristow procedure for recurrent anterior dislocations of the shoulder retrospectively. Only one redislocation occurred in 20 shoulders (six women and 13 men) with an average follow-up of 7.7 years. All patients were satisfied and experienced improved stability. Three patients showed arthritic changes (two mild and one moderate), which, surprisingly, were also seen in the opposite shoulder.

We therefore conclude that the occurrence of arthropathic changes after surgical stabilisation is based on multiple factors, with the initial dislocation playing a major role.

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Last Updated February 2, 2006

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