Osteoarthritis: a problem of growth not decay

Research output: Contribution to journalLiterature reviewpeer-review

70 Citations (Scopus)


The traditional view of OA is that it is primarily a disease of articular cartilage that results, by altering the biomechanics of the joint, in secondary changes to the subchondral bone and, through secondary inflammation, other joint tissues. This focus on cartilage tends to ignore other musculoskeletal changes reported, especially those remote from affected joints. It has been proposed instead that generalized OA is a systemic musculoskeletal disorder with a metabolic component. Evidence for this position will be presented by summarizing changes identified in all the major musculoskeletal tissues. This will endeavour to show the links between these tissues, most of which have a common mesenchymal origin. Dysregulated tissue turnover, with the balance in favour of growth, will be seen to be a common thread underlying many of the changes described. It is proposed that the production of new tissue in the midst of existing tissue, in the wrong place and at the wrong time, could result in the changes observed and that reversion of cellular behaviour to an earlier, developmental-like, phenotype may provide a mechanism that could drive the disease process. New therapies may arise both from recognizing this whole musculoskeletal disease phenotype and by exploring what might be the factors underlying this cellular reversion.

Original languageEnglish
Pages (from-to)1452-1460
Number of pages9
Issue number10
Early online date21 May 2008
Publication statusPublished - Oct 2008


  • osteoarthritis
  • systemic disease
  • metabolic disease
  • aetiology
  • growth
  • hypertrophy
  • subchondral bone plate
  • iliac crest bone
  • knee osteoarthritis
  • articular-cartilage
  • in-vitro
  • rheumatoid-arthritis
  • osteo-arthritis
  • generalized osteoarthritis
  • femoral-head
  • body-weight


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