DEGENERATIVE JOINT DISEASE

..
Degenerative joint disease (DJD)
osteoarthritis (OA), osteoarthrosis
(synovial joint) (intervertebral disc joint)

55
80%

synovial


(extra-cellular ground substance)
collagen proteoglycan
Proteoglycan
proteoglycan aggregate (aggrecans) hyaluronic acid proteoglycan
aggregate proteoglycan monomer hyaluronic acid link protein
proteoglycan monomer (protein core) glycosaminoglycans (GAGs) (
mucopolysaccharides) GAGs 2 chondroitin sulfate
keratan sulfate chondroitin sulfate 2-isomer forms sulfate 4 6
galactosamine chondroitin-4-sulfate chondroitin-6-sulfate chondroitin sulfate
keratan sulfate keratan sulfate
GAGs hyaluronic acid
aggregation proteoglycans proteoglycan monomer aggregate
1

PROTEOGLYCAN MONOMER

1. proteoglycan aggregate proteoglycan monomer

Proteoglycan
(hydrophilic)

70-80%

proteoglycan
(proteolytic enzymes)
Collagen type II collagen
(tensile strength) collagen
collagen collagen
type II
collagen hydroxylysine glycoside carbohydrate
collagenase

 collagen
collagen
45% 90% collagen
collagen collagen
proteoglycans collagen

(chondrocyte) proteoglycan, collagen, link-proteins hyaluronic

acid

collagenase, proteinase, cathepsin D,
hyaluronidase

,
(inhibitor)
collagenase collagen, proteinase protein core, cathepsins D,
B1, F proteoglycan, hyaluronidase chondroitin sulfate

proteoglycan, collagen, cartilage matrix
subchondral bone
proteoglycan proteoglycan preoteoglycan aggregation
proteoglycan
chondroitin sulfate GAGs
keratan sulfate chondroitin sulfate chondroitin-4-sulfate
chondroitin-6-sulfate
collagen type I collagen collagen
collagenase
cartilage matrix
collagen network proteoglycan

GAGs proteoglycan
proteoglycan
3

 subchondral bone
(subchondral bone) (osteoblast)
subchondral bone
(osteophyte)
(subchondral bone cyst)
subchrondal bone (necrotic area)
subchondral bone
2

2.

wear-and-tear

 1983 American Rheumatism Association (ARA) (

1)
1. Osteoarthritis classification. ARA Diagnostic and Therapeutic Criteria Committee (1983)
I. Idiopathic
A. Localized
1. Hands: e.g. Heberden's and Bouchard's nodes, erosive interphalangeal arthritis, first
carpometacarpal joint
2. Feet: e.g. hallux valgus, hallux rigidus, contracted toes (hammer/cockup toes), talonavicular
hypertrophic osteoarthritis
3. Knee:
(a) Medial compartment
(b) Lateral compartment
(c) Patellofemoral compartment
4. Hip
(a) Excentric (superior)
(b) Concentric (axial, medial)
(c) Diffuse (coxae senilis)
5. Spine (particularly cervical and lumbar)
(a) Apophyseal
(b) Intervertebral (disc)
(c) Spondylosis (osteophytes)
(d) Ligamentous (hyperostosis, Forestier's disease, (DISH)
6. Other single sites: e.g. shoulder, temporomandibular joint, sacroiliac, ankle, wrist
B. Generalized: includes three or more areas above (Kellgren-Moore)
C. Calcium deposition disease
1. CPPD
2. Apatite
3. Destructive arthropathy (shoulder, knee)
II. Secondary
A. Post-traumatic
B. Congenital or developmental diseases
1. Hip diseases: e.g. Legg-Calve'-Perthes, congenital hip dislocation, slipped capital femoral
epiphysis, shallow acetabulum
2. Bone dysplasias: e.g. epiphyseal dysplasia, spondyloepiphyseal dysplasia,
osteomychondystrophy
C. Other bone and joint disorders; e.g. avascular necrosis, rheumatoid arthritis, gouty arthritis, septic
arthritis, Paget's disease, osteopetrosis, osteochondritis
D. Other diseases
1. Metabolic diseases: e.g. hemachromatosis, ochronosis, Gaucher's disease, hemoglobinopathy,
Ehlers Danlos
2. Endocrine diseases: e.g. diabetes mellitus, acromegaly, hypothyroidism, hyperparathyroidism
3. Neuropathic arthropathy
4. Mechanical and local factors: e.g. obesity (?), unequal lower extremity length, extreme
valgus/varus deformity
5. Miscellaneous: eg. frostbite, Kashin-Beck disease, Caisson's disease






( 10 )


(bony
enlargment) (effusion)


(crepitus)
(distal
interphalangeal joint; DIP), (proximal interphalangeal joint; PIP),
, (1st metatarsophalangeal joint; MTP), (1st
carpometacarpal joint; CMC),

1.


Heberdens's node


monosodium urate
(Bouchard'd node)
Heberden's node
(metacarpophalangeal)

Heberden's bouchard's node
(square)

2.

(abduction) bunion

3. (temporomandibular joint)


4.




(crepitus)



(noninflammatory
synovial fluid) (mild inflammatory synovial fluid)

5.

(limp)

(external rotation, flexion and adduction)

6.

(intervertebral disc), apophyseal
(osteophyte)




(anterior spinal artery)
vertebral

7.


1.
(ESR) ESR
2.

(noninflammatory synovial
fluid) 2,000 /.. mucin clot

3.

(subchondral bone
sclerosis), (osteophyte) (subchondral bone cyst)

1.





8




2.

2.1

ibuprofen

proteoglycans
proteoglycans hyaluronic acid

2.2 (chondroprotective agent)

cartilage matrix SP-54, glycosaminoglycan polysulfate
(Arteperon) heparinoids , glycosaminoglycan-peptide complex
(Rumalon)
preoteinase, metalloproteinase

proteoglycans
3. (intraarticular therapy)
3.1

(controlled study)
1-2

(tramacinolone acetohexanide)


(neuropathic arthropathy) collagen

proteoglycans

metalloproteinase
3.2 (intraarticular chondroprotective agents)
hyalruronic
glycosaminoglycan polysylfate glycosaminoglycan-peptide complex

4.

(superficial and deep heat)


active exercise passive exercise isometric exercise
progressive resistsive exercise

5.

10

:
1. Hough AJ. Pathology of osteoarthritis. In: Mc Carty DJ, Koopman WJ. eds. Arthritis and allied
conditions. 12th ed., Lea & Febiger: Phialdelphia, 1993; p 1699-1721
2. Howell DS, Pelletier JP. Etiopathogenesis of osteoarthritis. In: Mc Carty DJ, Koopman WJ. eds.
Arthritis and allied conditions. 12th ed., Lea & Febiger: Phialdelphia, 1993; p 1721-34
3. Schnitzer TJ. Management of osteoarthritis. In: Mc Carty DJ, Koopman WJ. eds. Arthritis and allied
conditions. 12th ed., Lea & Febiger: Phialdelphia, 1993; p 1761-9
4. Mankin HJ. Clinical features of osteoarthritis. In: Kelley WN, Harris ED, Ruddy S, Sledge CB. eds.
Textbook of rheumatology. 4th ed., WB Saunders: Philadelphia, 1993; p 1374-84
5. Rosenberg L. Structure and function of cartilage. In: Mc Carty DJ, Koopman WJ. eds. Arthritis and
allied conditions. 12th ed., Lea & Febiger: Phialdelphia, 1993; p 229-43

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