PT - JOURNAL ARTICLE AU - Margaux Boisson AU - Marie-Martine Lefèvre-Colau AU - François Rannou AU - Christelle Nguyen TI - Active discopathy: a clinical reality AID - 10.1136/rmdopen-2018-000660 DP - 2018 Apr 01 TA - RMD Open PG - e000660 VI - 4 IP - 1 4099 - http://rmdopen.bmj.com/content/4/1/e000660.short 4100 - http://rmdopen.bmj.com/content/4/1/e000660.full SO - RMD Open2018 Apr 01; 4 AB - In the late 1980s, the description by Modic and colleagues of elementary discovertebral changes detected on MRI (Modic classification) suggested for the first time a possible correlation between anatomical and clinical features in a subgroup of patients with non-specific chronic low back pain. Degenerative disc disease is frequent and usually asymptomatic, but Modic 1 changes in the vertebral endplates adjacent to a degenerated disc are associated with inflammatory-like chronic low back pain and low-grade local and systemic inflammation, which led to the concept of ‘active discopathy’. Active discopathy shares some similarities with acute flares of peripheral osteoarthritis. Likewise, what triggers disc activation and how it self-limits remain unknown. A better understanding of mechanisms underlying disc activation and its self-limitation is of clinical relevance because it may enable the design of more targeted pharmacological and non-pharmacological interventions for the subgroup of patients with chronic low back pain and active discopathy. Here, we narratively review current disc-centred biomechanical and biochemical hypotheses of disc activation and discuss evidence of interactions with adverse personal and environmental factors.