Defining the osteoarthritis patient: back to the future

Abstract

The history of osteoarthritis (OA) is important because it can help broaden our perspective on past and present controversies. The naming of OA, beginning with Heberden's nodes, is itself a fascinating story. According to Albert Hoffa, R. Llewellyn Jones and Archibald Edward Garrod, the name OA was introduced in the mid-nineteenth century by surgeon Richard von Volkmann who distinguished it from rheumatoid arthritis and gout. Others preferred the terms 'chronical rheumatism', 'senile arthritis', 'hypertrophic arthritis' or 'arthritis deformans'. A similar narrative applies to the concept of OA affecting the whole joint vs the 'wear-and-tear' hypothesis, inflammation and the role of the central nervous system (CNS). In the late nineteenth and early twentieth centuries, the Garrods (father and son) and Hermann Senator argued that OA was a whole joint disease, and that inflammation played a major role in its progression. Garrod Jnr and John Spender also linked OA to a neurogenic lesion 'outside the joint'. The remaining twentieth century was no less dynamic, with major advances in basic science, diagnostics, treatments, surgical interventions and technologies. Today, OA is characterized as a multi-disease with inflammation, immune and CNS dysfunction playing central roles in whole joint damage, injury progression, pain and disability. In the current 'omics' era (genomics, proteomics and metabolomics), we owe a great debt to past physicians and surgeons who dared to think 'outside-the-box' to explain and treat OA. Over 130 years later, despite these developments, we still don't fully understand the underlying complexities of OA, and we still don't have a cure.

Hydrostatic pressure-generated reactive oxygen species induce osteoarthritic conditions in cartilage pellet cultures

“…It has been forecast that in the US alone, approximately 50 million people will suffer from OA by the year 2020 1 , 2 . This degenerative joint disease is predominantly observed in elderly people, which historically resulted in the hypothesis that OA is a simple “wear-and-tear” disease of articular cartilage 3 , 4 . It was believed that the loss of articular cartilage subsequently results in altered biomechanics combined with cellular changes which over time led to severe changes of the subchondral bone, synovium, menisci, ligaments, periarticular muscles and nerves 5 .…”

Effect of Partial Fibula Osteotomy Combined with Arthroscopic Debridement Surgery in the Treatment of Medial Compartment Knee Osteoarthritis

“…The concept of osteoarthritis was first described by John K Spender in 1886, 4 who described as swelling and pain of the knee with limited joint movement. In 1907, Archibald E Garrod first differentiated osteoarthritis from rheumatoid arthritis.…”

“…In 1907, Archibald E Garrod first differentiated osteoarthritis from rheumatoid arthritis. 4,5 Cartilage damage is the major pathologic feature for the osteoarthritis and knee joint replacement is an effective treatment for the patients with irreversible cartilage damage. Patients with knee osteoarthritis often have knee inversion though some patients have knee eversion.…”

Traumatic-Induced Coagulopathy as a Systems Failure: A New Window into Hemostasis

“…[100][101][102][103][104] These same factors are upregulated, albeit at lower levels, to perpetuate chronic disease. 105,106 In these traumatic injury and pathological states, a subject that has received little attention is the role the CNS and sympathetic/parasympathetic outflows play in linking cardiovascular function to coagulopathy and organ dysfunction. An important link in the chain is ventriculoarterial (VA) coupling, which optimizes the energy transfer of blood from the left ventricle (LV) to the systemic circulation and tissues, with minimal losses in friction and heat.…”