RESEARCH - Osteoarthritis: a problem of growth not decay?

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Rheumatology Advance Access published online on May 21, 2008

Rheumatology, doi:10.1093/rheumatology/ken199

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Review

Osteoarthritis: a problem of growth not decay?

R. M. Aspden

Department of Orthopaedics, University of Aberdeen, Institute of

Medical Sciences, Aberdeen, UK

Abstract

The traditional view of OA is that it is primarily a disease of

articular cartilage that results, by altering the biomechanics of the

joint, in secondary changes to the subchondral bone and, through

secondary inflammation, other joint tissues. This focus on cartilage

tends to ignore other musculoskeletal changes reported, especially

those remote from affected joints. It has been proposed instead that

generalized OA is a systemic musculoskeletal disorder with a metabolic

component. Evidence for this position will be presented by summarizing

changes identified in all the major musculoskeletal tissues. This will

endeavour to show the links between these tissues, most of which have

a common mesenchymal origin. Dysregulated tissue turnover, with the

balance in favour of growth, will be seen to be a common thread

underlying many of the changes described. It is proposed that the

production of new tissue in the midst of existing tissue, in the wrong

place and at the wrong time, could result in the changes observed and

that reversion of cellular behaviour to an earlier,

developmental-like, phenotype may provide a mechanism that could drive

the disease process. New therapies may arise both from recognizing

this whole musculoskeletal disease phenotype and by exploring what

might be the factors underlying this cellular reversion.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken199v1?papetoc

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