Diseases, Disorders information

Osteoarthritis is one of the most common rheumatic diseases in this country. Actually, for most rheumatologists it may not be the biggest part of their practice -probably rheumatoid arthritis is – because often these patients have mild disease or it’s treated either by the primary care physician or they end up going directly to the orthopedic surgeon who can, in some instances, cure the disease. It’s a slowly progressive, usually polyarticular disease, involving certain joints. Usually weight-bearing joints and certain joints in the hand, especially the DIP joints, PIP joints and also the first carpometacarpal or CMC joint. This is a woman who actually had giant cell arteritis and I was following her for that and she really never complained about any articular manifestations, unless her associated polymyalgia rheumatica flared up. So she had had these little nodules, Heberden’s nodes, for a number of years, thought they were ugly but other than that didn’t seem to care too much about them. I always wondered, why, if it involves weight-bearing joints, would it involve the DIP joints particularly. Evidently there is quite a bit of force because of the tendons crossing these joints, that there is actually quite a bit of force generated across these joints and that’s probably why the arthritis is predisposed to occur in this area.
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As opposed to rheumatoid arthritis, this is the disease that basically starts in the cartilage, whereas rheumatoid arthritis is a synovitis and then secondarily involves the cartilage. With osteoarthritis, for whatever reason, you have a breakdown of this cartilage and the cartilage is lost in a non-uniform fashion. Focal areas wear out first, and in this instance you also have these little bony outgrowths which clinically you can palpate, and these are osteophytes. Presumably these osteophytes are some halfhearted attempt at repair of the joint. Some of the major hallmarks are this focal loss of cartilage and osteophyte formation. Sometimes you also get subchondral cysts, which can also occur in other types of arthritis but they are particularly prominent in osteoarthritis. What happens is when you have a severe loss of cartilage in an area, sometimes a subchondral bone cracks and synovial fluid is literally forced into this area. When you take an x-ray it looks just like a lucency. That’s all it is, just a little bit of synovial fluid that’s been forced into the subchondral bone.
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There’s a lot of etiologic factors in primary osteoarthritis. Hereditary factors do appear to be important. Maybe some sort of abnormality of collagen production in the cartilage. Certainly the type of osteoarthritis involving the hands, if you talk to a patient a lot of times they will tell you that their parents and grandparents may have had the same thing. Stress from impact loading. This is probably more of an aggravating factor. They’ve actually done studies looking at professional basketball players and showing that they didn’t have an increased incidence of osteoarthritis later in life, unless they had had a major knee injury, like a torn ACL.