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A better insight into the realities behind osteoarthritis
In this issue of the Annals of Rheumatic Diseases, Tan et al1 report the results of high-resolution magnetic resonance imaging (hrMRI) of interphalangeal joints of 20 subjects who had “clinically osteoarthritic” and painful finger joints for <l year. The MRI observations are supported by histological and radiographic examination of dissecting room specimens of apparently non-arthritic interphalangeal joints from three elderly people, and are an extension of earlier work by the same group of investigators.2 Their findings indicate that structural changes in the collateral ligaments of the interphalangeal joints were uniformly present even when the articular cartilage appeared normal. The authors concluded that “ ... the role of ligaments as an initiating or perpetuating factor in the pathogenesis of non-traumatic knee and hip disease merits attention. The damage evident within the small joint collateral ligaments raises the possibility that this is the principal site of wear and tear in early disease.”
Observations such as these emphasise that the aetiology and progression of osteoarthritis should not be thought of as being invariably attributable to a single tissue, such as articular cartilage, but as possibly due to disease in any of the tissues of the affected organ, the diarthrodial joint, including the subchondral bone, synovium, capsule, periarticular muscles, sensory nerve endings and meniscus (if present). Supporting ligaments should be added to the list.
Although reviews of osteoarthritis often contain a statement to the effect that it is not merely a disease of cartilage, the large amounts of time, money and brainpower that have been invested in attempts to develop “chondroprotective” drugs and efforts to find the best ways to image minuscule (and clinically meaningless) changes in articular cartilage and to identify biomarkers of cartilage damage in osteoarthritis are evidence that we really …
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