Review of pathogenesis and treatment of degenerative joint disease.

This research article explores the treatment of degenerative joint disease (osteoarthritis) in relation to the pathogenesis of five specific clinical scenarios. It also discusses the significant role direct damage to articular cartilage, synovitis, capsulitis, and depletion of matrical glycosaminoglycans and proteoglycans play in the disease. Solutions range from preventative measures, treatment of contributing soft tissue disease, to attempts at treating articular cartilage loss or degeneration.

Understanding Various Clinical Scenarios

• The article categorizes osteoarthritis into five main clinical situations to provide better understanding. These are: (i) arthritis in high motion joints associated with synovitis; (ii) arthritis associated with low motion joints; (iii) “non-progressive” articular cartilage erosion; (iv) arthritis secondary to other identified issues like intra-articular fractures, ligamentous damage, wounds, septic arthritis, osteochondrosis; and (v) chondromalacia of the patella.

Role of Damage, Depletion and Disease Processes

• The study highlights that other than the direct damage to the articular cartilage, synovitis (inflammation of the synovial membrane) and capsulitis (inflammation of a joint capsule) also have significant influence in the disease process.
• Additionally, it delves into the inadequate healing response of damaged articular cartilage and how the depletion of matrical glycosaminoglycans and proteoglycans (components of the joint cartilage) play a crucial role in this disease.

Treatment Principles for Degenerative Joint Disease

• The publication details three main principle areas of treatment for degenerative joint disease.
• The first principle revolves around the prevention and treatment of primary causes, which includes considerations on the effects of track surface, shoeing, intra-articular fractures, septic arthritis and osteochondritis dissecans.
• The second principle is focused on the treatment of active soft tissue disease contributing to articular cartilage degeneration. This may involve rest, physical therapy, synovectomy (surgical removal of a diseased synovial membrane), administration of anti-inflammatory drugs, sodium hyaluronate, and polysulfated glycosaminoglycans.
• Lastly, the article discusses the attempts at treating articular cartilage loss or degeneration. Here, the research discusses potential procedures like articular cartilage curettage (scraping of diseased cartilage), subchondral bone drilling, osteophyte removal (removal of bony projections associated with the degeneration of cartilage at joints), articular cartilage grafting and arthrodesis (surgical immobilization of a joint).