Pathology of Osteoarthritis

Osteoarthritis
degenerative joint disease
Definition:
Osteoarthritis is the most common joint disorder. It's a part of aging and is an important cause of physical disability in
individuals over the age of 65.
The fundamental feature of osteoarthritis is degeneration of the articular cartilage;

any structural changes in the underlying bone are secondary.
primary osteoarthritis 95% (most cases) secondary osteoarthritis less than 5%
Osteoarthritis appears insidiously with age Osteoarthritis strikes in youth,
there is typically some predisposing condition, such as :

without apparent initiating cause
- previous traumatic injury,
- developmental deformity,
- underlying systemic disease such as :
diabetes, ochronosis, hemochromatosis, or marked obesity.
the disease is usually oligoarticular

(i.e., affecting only a few joints). involves one or several predisposed joints.
- Gender has some influence;

knees and hands are more commonly affected in women, whereas hips are more commonly affected in men.
Morphology :
The earliest structural changes include :
1- enlargement,
2- proliferation, of the chondrocytes in the superficial part of the articular cartilage
3- and disorganization
- This process is accompanied by increasing water content of the matrix with decreasing
concentration of the proteoglycans.
- Subsequently, vertical and horizontal fibrillation and cracking of the matrix …occur as the superficial layers of the cartilage are
degraded.
- Gross examination at this stage reveals a soft granular articular cartilage

surface.
- Eventually, full-thickness portions of the cartilage are lost, and the

subchondral bone plate is exposed resulting in :
1- Friction smooths and burnishes the exposed bone, giving it the

appearance of polished ivory (bone eburnation).
2- sclerosis and thickening of the underlying cancellous bone.
3- Small fractures can dislodge pieces of cartilage and subchondral

bone into the joint, forming loose bodies (joint mice).
4- The fracture gaps allow synovial fluid to be forced into the

subchondral regions to form fibrous walled cysts.
5- Mushroom-shaped osteophytes (bony outgrowths) develop at the

margins of the articular surface.
6- In severe disease, a fibrous synovial pannus covers the peripheral

portions of the articular surface.
Pathogenesis :
Articular cartilage bears the brunt of the degenerative changes in osteoarthritis.
- Normal articular cartilage performs two functions:

(1) along with the synovial fluid, it provides virtually friction-free movement within the joint;
(2) in weight-bearing joints, it spreads the load across the joint surface in a manner that allows the underlying bones to
……absorb shock and weight.
These functions require the cartilage to be elastic (i.e., to regain normal architecture after compression) and to have high
tensile strength.
These attributes are provided by proteoglycans and type II collagen, both produced by chondrocytes.
- As with adult bone, articular cartilage constantly undergoes matrix degradation and replacement. Normal chondrocyte
function is critical to maintain cartilage synthesis and degradation; any imbalance can lead to osteoarthritis.
Chondrocyte function can be affected by a variety of influences :

- mechanical stresses and aging nevertheless figure prominently.
- Genetic factors also seem to contribute to osteoarthritis susceptibility, particularly in the hands and hips,
…but the responsible genes are not known.
- The risk of osteoarthritis is also increased with increasing bone density,
sustained high estrogen levels.
- Regardless of the inciting stimulus, early osteoarthritis is marked by degenerating cartilage containing more water and
less proteoglycan.
- The collagen network is also diminished, presumably as a result of decreased local synthesis and increased breakdown;
chondrocyte apoptosis is increased.
In response to these degenerative changes, chondrocytes in the deeper layers proliferate and attempt to "repair" the
damage by synthesizing new collagen and proteoglycans.
Clinical course :
Osteoarthritis is an insidious disease, predominantly affecting patients beginning in their 50s and 60s.
Characteristic symptoms include :

1- deep,
2- aching pain exacerbated by use
3- morning stiffness,
4- crepitus (grating or popping sensation in the joint),
5- limited range of movement.
• Osteophyte impingement on spinal foramina can cause nerve root compression with radicular pain, muscle spasms,
muscle atrophy, and neurologic deficits.
• Hips, knees, lower lumbar and cervical vertebrae, proximal and distal interphalangeal joints of the fingers, first
carpometacarpal joints, and first tarsometatarsal joints of the feet are commonly involved.
• Heberden nodes in the fingers, representing prominent osteophytes at the distal interphalangeal joints, are characteristic
in women.
• Aside from complete inactivity, there is no predicted way to prevent or halt the progression of primary osteoarthritis; it
can stabilize for years but is generally slowly progressive.
• With time, significant joint deformity can occur, but unlike rheumatoid arthritis , fusion does not take place.

Pathology of Osteoarthritis

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Osteoarthritis

degenerative joint disease

The fundamental feature of osteoarthritis is degeneration of the articular cartilage;

primary osteoarthritis 95% (most cases) secondary osteoarthritis less than 5%

Osteoarthritis appears insidiously with age Osteoarthritis strikes in youth,

there is typically some predisposing condition, such as :

the disease is usually oligoarticular

- Gender has some influence;

- Gross examination at this stage reveals a soft granular articular cartilage

- Eventually, full-thickness portions of the cartilage are lost, and the

1- Friction smooths and burnishes the exposed bone, giving it the

2- sclerosis and thickening of the underlying cancellous bone.

3- Small fractures can dislodge pieces of cartilage and subchondral

4- The fracture gaps allow synovial fluid to be forced into the

5- Mushroom-shaped osteophytes (bony outgrowths) develop at the

6- In severe disease, a fibrous synovial pannus covers the peripheral

- Normal articular cartilage performs two functions:

Chondrocyte function can be affected by a variety of influences :

Characteristic symptoms include :

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