Osteoarthritis: the Most Prevalent Musculoskeletal Disease

Running Head: OSTEOARTHRITIS 1
Osteoarthritis
Name
Institutional Affiliation

OSTEOATHRITIS 2
Introduction
Osteoarthritis is the most prevalent musculoskeletal disease in the world. It is a group of
heterogeneous conditions and affects primarily the articular joints. There is cartilage
deterioration in joints which leads to pain, stiffness as well as impaired movement. According to
the World Health Organization, it is the leading cause of disability in older individuals. Men
make up 9.6% of those who are 60 years and above with symptomatic Osteoarthritis globally
while women make up 18.0% of this population. It is estimated that by 2050, 20% of the global
population will be aging. Of this, 15% will have osteoarthritis (Wittenauer, Smith & Aden,
2013).The National Institute of Health and Welfare in Australia estimates that about 2.2 million
people in Australia had Osteoarthritis from 2017 to 2018. This made up 9.3% of the country’s
population. As of 2015, Osteoarthritis made up 19% of the burden from musculoskeletal
conditions in Australia. 3 out of 5 people with the disease were female (Australian Institute of
Health and Welfare, 2019). There are more men with the disease below the age of
40. Women make the bulk of those with Osteoarthritis above 50 years of age. With
improvements in healthcare and an increase of such conditions as obesity, Osteoarthritis is
expected to be a major health issue in the future in all countries. Data on Osteoarthritis is limited
by the different definitions given to the disease as well as the measures used for its study and
management. The focus of this paper will be on the causes, treatments, and diagnosis of the
disease (Xing et al., 2016).
Aetiology and pathogenesis
Osteoarthritis generally progresses slowly and might a long time before chronic symptoms
appear. Genetic, biomechanical and biological factors influence the epidemiology of the disease.

OSTEOATHRITIS 3
Osteoarthritis is classified into either primary or secondary form. The primary type is also called
the idiopathic kind. It occurs in aging individuals. There may be many causes for the disease
such as genetic predisposition. The secondary form is as a result of disease or a condition. This
changes the internal cartilage environment. The causes can be endocrine, for trauma, infection,
and congenital abnormalities or metabolic. Conditions that can lead to secondary Osteoarthritis
include Williams syndrome and gout. Despite the different etiology of the two types, the
pathology and symptoms are similar (Allen & Golightly, 2015).
Osteoarthritis can affect any joints in the body. It, however, mainly affects the joints of thumb
carpometacarpal, first metatarsophalangeal, knee, hip, zygapophyseal of the lumbar and cervical
vertebrae and proximal and distal interphalangeal joints. Articular cartilage is mostly affected. A
large number of other close tissues are also affected (periarticular tissues). The main factors that
may lead to the development of the disease are aging, obesity, increased bone density, trauma,
occupational injury, genetics, race, ethnicity, and gender (Palazzo et al.,2016).
Hyaline cartilage can be described as alymphatic, avascular and aneural. Osteoarthritis starts
through the injury of tissues through mechanical means, defects of cartilage metabolism or
inflammatory mediators. Repair then occurs. A result is that collagen and proteoglycans are
produced. Enzymes degrade the cartilage with cytokine being produced. The chondrocytes then
undergo apoptosis. Subchondral cysts develop from subchondral bone stiffening and subsequent
infarction. It is the bone repair mechanisms that lead to the development of osteophytes and
subchondral sclerosis. Synovial fluid is produced in larger quantities and is less viscous due to
synovium inflammation and thickening. The stress on ligaments and periarticular tendons lead to
contractures and tendinitis. The joint thus becomes less mobile with the muscles becoming thin
and providing less support. In the spine, posterior longitudinal ligaments proliferate and thicken

OSTEOATHRITIS 4
as a result. Transverse bars thus encroach the spinal cord. Lumbar Spinal Stenosis results from
the compression of the posterior canal due to ligamenta flava undergoing hyperplasia and
hypertrophy (Kontzias, 2018).
It has also been established that Inflammatory agents such as lipid derivatives, cytokines, and
reactive oxygen and nitrogen species lead to cell activation at cartilage, synovium as well as
subchondral bone. (Haseeb & Haqqi, 2013). Matrix metalloproteinases are then released which
degraded the cartilage. Higher concentrations of leptin and serum lipids levels are also linked to
osteoarthritis. The incidences of individuals with obesity having hand osteoarthritis imply
another role of obesity other than putting pressure on joints. This is through adipose tissue.
Inflammation results from nutrient overload with the production of adipokines and cytokines.
The deregulation of microRNAs results in activation of the compliment system-T lymphocytes,
B-lymphocytes and macrophages are sensitized. All this leads to tissue degradation (Wang et al.,
2015).
Besides, some loci are linked to osteoarthritis of the hip. These are VEGF and COL11A1 genes
and one close to the NCOA3 gene (nuclear receptor coactivator 3). Studies have also associated
different genes with apoptosis and pathogenesis. Individuals with parents with osteoarthritis are
more likely to develop the disease (Tsezou, 2014). It has been observed that knee pain is
prevalent or worsening of symptoms for those who have a parent who had a knee replacement.
There are other explanations offered for the development of the disease. Aging is thought to lead
to osteoarthritis through a decline of cellular mechanisms responsible for tissue homeostasis
which lowers responses to joint injury and loss, as well as stress. Thinning of cartilage, oxidative
damage, and muscle weakness are contributors to osteoarthritis in older individuals. Obesity, on