Insights from Imaging on the Epidemiology and Pathophysiology of Osteoarthritis
Section snippets
Epidemiology
In epidemiologic investigation, OA is typically defined using conventional radiographs, and less frequently self report. The reported prevalence of OA varies according to the evaluation method used. The characteristic features of OA scored on radiographs are osteophytes (osteocartilaginous growths); subchondral sclerosis; and joint space narrowing (Fig. 1).
The presence and severity of OA is typically classified using the Kellgren and Lawrence grading system,5 a system that is heavily dependent
Pathophysiology of osteoarthritis
Early investigators tended to regard OA as an isolated disease of articular cartilage. Although cartilage loss is a prominent feature of OA, contemporary models recognize that the entire synovial joint organ is affected by OA. OA can be viewed as the clinical and pathologic outcome of a range of disorders that results in structural and functional failure of the synovial joint organ with loss and erosion of articular cartilage; subchondral bone alteration; meniscal degeneration; a synovial
Insights from imaging on symptom genesis
The structural determinants of pain and mechanical dysfunction in OA are not well understood, but are believed to involve multiple interactive pathways that are best framed in a biopsychosocial framework (posits that biologic, psychologic, and social factors all play a significant role in pain in OA).36, 37 Local to the joint there are a number of tissues that contain nociceptive fibers and these are the likely sources of pain in OA. The subchondral bone, periosteum, periarticular ligaments,
Insights from imaging on disease pathogenesis
Traditionally, measurement of OA structural change has been performed using radiographs. Standardized techniques for measuring joint space width in the medial tibiofemoral compartment, using standardized radiographic protocols, have become accepted for quantifying changes in knee OA.89 Because of inherent limitations in conventional radiograph technology, further research and development has investigated other techniques that may improve the assessment of disease, its early development, and its
Summary
Recent studies, particularly those with an emphasis on MR imaging, are providing unique insights into the relation between structure identified on imaging and symptom and disease genesis. The traditional predominant focus of imaging studies and preclinical investigation is on hyaline cartilage. The subchondral bone, periosteum, periarticular ligaments, periarticular muscles, synovium, and joint capsule are all richly innervated, however, and are the likely source of nociception in OA. In
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Cited by (27)
Inter-observer and intra-observer reliability of mechanical axis alignment before and after total knee arthroplasty using long leg radiographs
2016, KneeCitation Excerpt :Osteoarthritis (OA) in the knee joint is the most common disorder in orthopaedics and is characterised by structural and functional failure of the synovial joint tissue with loss and erosion of articular cartilage, sub-chondral bone alteration and meniscal degeneration [1,2].
The course of ultrasonographic abnormalities in knee osteoarthritis: 1year follow up
2014, Osteoarthritis and CartilageCitation Excerpt :So far no disease modifying drugs for OA are available, mainly due to the fact that pathophysiology and relation with subsequent signs and symptoms are not completely understood. OA is not merely a disease of bone and cartilage but it affects the entire joint including soft tissue structures like menisci and synovium3. Visualizing these (peri)articular structures during the course of OA might contribute to knowledge about early diagnosis of OA and prognosis.
An OA phenotype may obtain major benefit from bone-acting agents
2014, Seminars in Arthritis and RheumatismThe epidemiology of osteoarthritis
2014, Best Practice and Research: Clinical RheumatologyOsteoarthritis. A Review of Strengths and Weaknesses of Different Imaging Options.
2013, Rheumatic Disease Clinics of North AmericaCitation Excerpt :MR imaging has helped OA investigators to move away from the traditional notion that the OA is an isolated disease of articular cartilage. Contemporary models recognize the involvement of the entire synovial joint organ and view OA as the clinical and pathologic outcome of a range of disorders that results in structural and functional failure of the synovial joint organ with loss and erosion of cartilage, subchondral bone alteration, meniscal damage, synovitis, and overgrowth of bone (osteophytes).34 Nonetheless, radiologic-surgical correlation studies have shown that direct visualization of joint tissues by arthroscopy is more accurate in diagnosing cartilage loss and meniscal and ligamentous damages,35–37 and thus in the clinical setting, arthroscopic examination remains the gold standard investigation before definitive treatment planning.37
Forefoot angle determines duration and amplitude of pronation during walking
2013, Gait and PostureCitation Excerpt :The greater amplitude and duration of foot pronation would hypothetically result in increased amplitude and prolonged femoral internal rotation. Hip external rotator muscles would be active to control the internal rotation and therefore increase the compressive forces on the femoral head resulting in altered hip joint loading patterns [28,29]. Over time, the repetitive stresses may contribute to the development of hip osteoarthritis [30].