Osteoarthritis is an idiopathic disease that characterized by degeneration of articular cartilage.

It is a
progressive disorder of joints that are movable associated with aging and trauma. It is caused by the
cartilage (hyaline) ulceration leaving the bone exposed causing severe pain. It develops as wear and
tears on the joints breaks down the cartilage in the joint, causing bone to rub on bone. It is the most
common cause of disability in older adults and can affect any joint in the body especially the hands,
knees and hips

Due to an active reaction of chondrocytes in the articular cartilage and inflammatory cells in the
surrounding tissues, the pathophysiology of OA involves cartilage destruction and bone remodeling. The
enzymes released by

these cells break down collagen and proteoglycans, causing the articular cartilage to break down.

Joints

The normal articular surface of synovial joints consists of articular cartilage (composed of chondrocytes)
surrounded by an extracellular matrix that includes various macromolecules, most importantly
proteoglycans and collagen. The cartilage facilitates joint function and protects the underlying
subchondral bone by distributing large loads, maintaining low contact stresses, and reducing friction at
the joint.

Synovial fluid is formed through a serum ultrafiltration process by cells that form the synovial membrane
(synoviocytes). Synovial cells also manufacture hyaluronic acid (HA, also known as hyaluronate), a
glycosaminoglycan that is the major noncellular component of synovial fluid. Synovial fluid supplies
nutrients to the avascular articular cartilage; it also provides the viscosity needed to absorb shock from
slow movements, as well as the elasticity required to absorb shock from rapid movements.

Articular Cartilage Pathology

The articular cartilage covers the ends of the bones where they meet. This cartilage consists of a matrix
of proteins and molecules that support the tissue. The matrix components are synthesized and secreted
by cells called chondrocytes, which are also embedded in the matrix. The balance between the
breakdown and repair of the matrix is essential to the health of the articular cartilage. OA occurs when
there is an imbalance in the breakdown and synthesis of the matrix

Subchondral Bone Pathology

The subchondral bone is located underneath the articular cartilage. It functions to absorb the shock
experienced during movement. This portion of the bone consists of a subchondral bone plate (made of
cortical bone) and a deeper trabecular bone and bone marrow space. The subchondral bone is altered
through bone modeling and remodeling. However, during OA, these processes are affected. It is unclear
whether changes in the articular cartilage during OA precede subchondral bone pathology or occur
simultaneously.

Synovial Membrane Pathology

The synovial membrane is the synovial fluid-filled connective tissue that lines the inner surface of the
joint. Like with the subchondral bone, it is not clear whether changes to the synovial membrane during
OA are a response to the other changes previously mentioned or occur as primary changes of OA.

Meniscus Pathology

The meniscus is a thin fibrous cartilage between the surfaces of the joint. This tissue is typically torn,
fragmented, or completely destroyed in OA. Thus meniscal degeneration is fairly common in OA.
Degeneration begins in the deeper layers of the tissue and works its way out to the articular surfaces.
 PREDISPOSING PRECIPITATING
FACTOR FACTORS
 Occasionally Alcoholic
 Age: 66 years old drinker
 Sex: Female  Obesity
 

Decrease in proteoglycan content in

the bone matrix

Softening and loss of elasticity by the

cartilage

Chondrocytes proliferate and

increase their synthesis of
proteoglycans and collagen

Progressive destruction of
lysosomal enzymes

Cartilage becomes increasingly

susceptible to joint friction

Changes in Collagen synthesis,

minimizing compressibility of the
cartilage

Collagen fibers rupture

Reference:

Centers for Disease Control and Prevention. (2020, July 27). Osteoarthritis (OA). Centers for
Disease Control and Prevention. Retrieved September 3, 2022, from
https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Carlos J Lozada, M. D. (2021, December 10). Osteoarthritis. Practice Essentials, Background,

Anatomy. Retrieved September 3, 2022, from
https://emedicine.medscape.com/article/330487-overview#a3