Osteoarthritis: pathogenesis and therapeutic interventions for a whole joint disease

Abstract

Osteoarthritis (OA) is an invalidating disease characterized by progressive cartilage degradation. OA is the most prevalent arthritic disease and leading cause of disability that effects approximately 34% of the population in the United states over age 65. Also in the Netherlands, approximately 30% of persons aged 65 and older are affected in either the hip or knee joint by this severely disabling disease. Due to the obvious cartilage pathology, research has much focused on articular cartilage and chondrocyte pathobiology. Over the years more knowledge has been gained on complex biochemical and biomechanical influences of chondrocyte behavior. During the past decade, however, pathologic cellular and structural changes in subchondral and trabecular bone, ligaments, synovium, supporting musculature, fibrocartilagenous structures such as the meniscus, and intra-articular fat tissue support the idea that osteoarthritis is not just a cartilage problem. In the current dogma, OA is explained as ‘a whole joint disease’ that involves a degenerative continuum between multiple joint tissues and cell types.