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Rheumatology Advance Access originally published online on May 21, 2008
Rheumatology 2008 47(10):1452-1460; doi:10.1093/rheumatology/ken199
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

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Osteoarthritis: a problem of growth not decay?

R. M. Aspden

Department of Orthopaedics, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK.

Correspondence to: R. M. Aspden, Department of Orthopaedics, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK. E-mail: r.aspden{at}abdn.ac.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.

KEY WORDS: Osteoarthritis, Systemic disease, Metabolic disease, Aetiology, Growth, Hypertrophy

Submitted 20 February 2008; revised version accepted 15 April 2008.
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