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Degenerative Joint Disease

Synonyms: Osteoarthritis

Advanced osteoarthritis of femoral head: whole mount of case shown in Fig. 1.

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Definition

Group of degenerative pathologic changes of the joints related directly to age, trauma and occupation.

Clinical features

Loss of cartilage thickness leads to:
- narrowing of joint space
- loss of stability of chondro-osseous junction
Changes:
- centered in cartilage (notorious for its poor capacity for repair)1,2
- more prominent on joint surface exposed to:
  - friction
  - weight bearing
  - movement
- also in areas of joint not subject to these mechanical forces 3

Pathogenesis

Degenerative
Not inflammatory4
Osteophytes at margins of joints progress through discrete stages of cartilage differentiation:5
- cartilage degradation believed to be mediated by cytokines, particularly IL-16
Loss of chondroitin sulfate matrix precedes mechanical attrition of cartilage

Gross Pathology

Pathologic changes:7–9
- related directly to age
- conditioned by use and occupation
Earliest change is even degeneration of hyaline cartilage of articular surface:
- leads to:
  - thinning of cartilage (Figs 1
    Fig. 1: Advanced osteoarthritis of femoral head: gross appearance, showing near-total disappearance of articular cartilage.
    )
  - compensatory overgrowth of apposite joint surface
Secondary features:
- sometimes cysts close to surface in head of femur surrounded by dense bone and containing fluid or loose connective tissue3,10–12 (Fig. 2
  Fig. 2: Specimen radiograph of femoral head with osteoarthrosis. Note irregular thinning of articular cartilage and formation of a subchondral cyst surrounded by sclerotized bone.
  )
- changes in capsular and synovial nerves13,14

Histopathology

Once the articular cartilage disappears (Figs 3 and 4
Fig. 3: Advanced osteoarthritis of femoral head: whole mount of case shown in Fig. 1.
Fig. 4: Osteoarthritis. The articular cartilage has been replaced by a thin layer of fibrous tissue.
):
- the two bony surfaces are brought into contact, with progressive thickening of trabeculae (‘eburnation’)
- perichondrial activity increases at the joint periphery, with formation of Heberden's nodes
- synovial membrane may:
  - remain normal
  - undergo thickening, with formation of papillary metaplastic masses of cartilage, bone, or adipose tissue:
    - detachment of these masses gives rise to intra-articular loose bodies (rice bodies)
In advanced stages:
- especially in hip:
  - synovial hyperplasia
  - hyperemia
  - lymphocytic infiltration
- may be foci of subchondral acute inflammation resembling osteomyelitis, but probably non-infectious15

Variants

Neuropathic Arthropathy (Charcot's Joint)

Often large amounts of dead bone and cartilage particles embedded in synovial membrane16

Chondromalacia Patellae

Changes indistinguishable from degenerative joint disease17

Diagnosis

Variants

Neuropathic Arthropathy (Charcot's Joint)

Particularly destructive variant (Figs 5 and 6
Fig. 5: Neuropathic changes in wrist secondary to syringomyelia.
Fig. 6: Neuropathic changes in wrist secondary to syringomyelia.
)
Usually slowly progressive18

Chondromalacia Patellae

Obscure etiology
Softening, fibrillation, fissuring, and erosion of articular cartilage of patella19

Differential Diagnosis

Select up to 2 differential diagnoses to compare with Degenerative Joint Disease

Changes should not be confused with rheumatoid arthritis

References

1 Hamerman D. The biology of osteoarthritis. N Engl J Med. 1989;320:1322–1330.

2 Sokoloff L. Pathology and pathogenesis of osteoarthritis. McCarty DJ editors. Arthritis and applied conditions. ed. 9. Philadelphia: Lea & Febiger; 1979.

3 Harrison MHM, Schajowicz F, Tureta J. Osteoarthritis of the hip. A study of the nature and evolution of the disease. J Bone Joint Surg (Br). 1953;35:598–626.

4 Gardner DL, Salter DM, Oates K. Advances in the microscopy of osteoarthritis. Microsc Res Tech. 1997;37:245–270.

5 Aigner T, Dietz U, Stöss H, Von der Mark K. Differential expression of collagen types I, II, III, and X in human osteophytes. Lab Invest. 1995;73:236–243.

6 Sadouk M, Pelletier J-P, Tardif G, Klansa D, Cloutier J-M, Martel-Pelletier J. Human synovial fibroblasts coexpress IL-1 receptor Type I and Type II mRNA. The increased level of the IL-I receptor in osteoarthritic cells is related to an increased level of the Type I receptor. Lab Invest. 1995;74:347–355.

7 Collins DH. The pathology of articular and spinal diseases. London: Edward Arnold & Co.; 1949;.

8 Hirsch C, Schajowicz F, Galante J. Structural changes in the cervical spine. A study on autopsy specimens in different age groups. Acta Orthop Scand (Suppl). 1967;109:7–77.

9 Bennett GA, Waine H, Bauer W. Changes in the knee joint at various ages. New York: Commonwealth Fund; 1942;.

10 Jayson MI, Rubenstein D, Dixon AS. Intra-articular pressure and rheumatoid geodes (bone ‘cysts’). Ann Rheum Dis. 1970;29:496–502.

11 Mankin HJ. The reaction of articular cartilage to injury and osteoarthritis. N Engl J Med. 1974;291:1285–12921335–1340.

12 Rhaney K, Lamb DW. The cysts of osteoarthritis of the hip. A radiological and pathological study. J Bone Joint Surg (Br). 1955;37:663–675.

13 Di Francesco L, Sokoloff L. Lipochondral degeneration of capsular tissue in osteoarthritic hips. Am J Surg Pathol. 1995;19:278–283.

14 Rabinowicz T, Jacqueline F. Pathology of the capsular and synovial hip nerves in chronic hip diseases. Pathol Res Pract. 1990;186:283–292.

15 O'Connell JX, Nielsen GP, Rosenberg AE. Subchondral acute inflammation in severe arthritis: a sterile osteomyelitis?. Am J Surg Pathol. 1999;23:192–197.

16 Horwitz T. Bone and cartilage debris in the synovial membrane. Its significance in the early diagnosis of neuro-arthropathy. J Bone Joint Surg (Am). 1948;30:579–588.

17 Haliburton RA, Sullivan CR. The patella in degenerative joint disease. A clinicopathologic study. Arch Surg. 1958;77:677–683.

18 Norman A, Robbins H, Milgram JE. The acute neuropathic arthropathy. A rapid, severely disorganizing form of arthritis. Radiology. 1968;90:1159–1164.

19 Outerbridge RE. The etiology of chrondromalacia patellae. J Bone Joint Surg (Br). 1961;43:752–757.

Last updated: 6 Mar 2006