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The role of the cartilage matrix in osteoarthritis

Nature Reviews Rheumatology volume 7, pages 50–56 (2011)Cite this article

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Abstract

Osteoarthritis (OA) involves all the structures of the joint. How the disease is initiated and what factors trigger the disease process remain unclear, although the mechanical environment seems to have a role. Our understanding of the biology of the disease has been hampered by the lack of access to tissue samples from patients with early stage disease, because clinically recognizable symptoms appear late in the osteoarthritic process. However, new data about the early processes in articular cartilage and new tools to identify the early stages of OA are providing fresh insights into the pathological sequence of events. The progressive destruction of cartilage involves degradation of matrix constituents, and rather active, yet inefficient, repair attempts. The release of fragmented molecules provides opportunities to monitor the disease process in patients, and to investigate whether these fragments are involved in propagating OA, for example, by inducing inflammation. The role of bone has not been fully elucidated, but changes in bone seem to be secondary to alterations in articular cartilage, which change the mechanical environment of the bone cells and induce them, in turn, to modulate tissue structure.

Key Points

  • Mechanical factors have a central role in the development of osteoarthritis and in cartilage breakdown; these processes can be modulated by variable load

  • Inflammation is an early and persistent event that might impair the ability of joint tissues to handle mechanical loads

  • Cartilage changes are early events that are coupled, via mechanical or soluble factors, to bone alterations

  • Involvement of tissues in osteoarthritis can be monitored by quantifying levels of released fragments of tissue matrix molecules and inflammation can be assessed by markers such as activated complement factors or cytokines

  • The results of tissue-destructive processes can be visualized by direct joint inspection in arthroscopy, as well as by imaging technology, particularly MRI, ultrasonography and radiography

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Figure 1: Properties of normal and osteoarthritic joints.
Figure 2: The molecular organization of normal articular cartilage.

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Acknowledgements

The authors gratefully acknowledge grant support from the National Institute of Arthritis and Musculoskeletal and Skin Disorders (NIAMS), the National Institutes of Health of the USA (NIH) and the Swedish Research Council. The immunostained images of COMP distribution were prepared by Karen King.

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  1. Department of Clinical Sciences, Section of Rheumatology, Lund University, BMC plan C12, Lund, SE-22184, Sweden

    Dick Heinegård & Tore Saxne

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D. Heinegård and T. Saxne contributed equally to all aspects of the preparation of this manuscript.

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Correspondence to Dick Heinegård.

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Heinegård, D., Saxne, T. The role of the cartilage matrix in osteoarthritis. Nat Rev Rheumatol 7, 50–56 (2011). https://doi.org/10.1038/nrrheum.2010.198

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