Skip to main content

Osteoarthritis: symptoms, signs and source of pain

Abstract

Osteoarthritis is the most common form of arthritis. The condition is characterised by loss or failure of the functional and/or biochemical integrity of the joint. The clinical symptoms include joint stiffness, pain and dysfunction, but the principal problem for the majority of patients is the pain. Although there are no pain receptors in the cartilage, the origin of the pain is thought to be due to stimulation of the A delta mechanoreceptors and the C polymodal nerve endings in the synovium and surrounding tissues. However, some of the pain experienced in and around the joints is referred pain or sympathetic efferent pain. In addition, there is a poor correlation of clinical symptoms with radiological or imaging appearance. This lack of correlation of clinical evaluation and imaging makes attempts at treatment difficult and compromises attempts to design studies and to evaluate the outcome of osteoarthritis in clinical trials.

This is a preview of subscription content, access via your institution.

REFERENCES

  • Abernathy, P. J., Townsend, P., Rose, R. M., et al. (1978). Is chondromalacia patellae a separate clinical entity?, J. Bone Jt. Surg. 60B, 205–210.

    Google Scholar 

  • Ahlback, S. (1968). Osteoarthritis of the knee: a radiographic investigation, Acta Radiol. 277 (Suppl.), 7–72.

    Google Scholar 

  • Alexander, C. (1960). Erosion of the femoral shaft due to patello-femoral osteoarthritis, Clin Radiol. 11, 110–113.

    Google Scholar 

  • Altman, R. D., Meenan, R. F., Hochberg, M. C., et al. (1983). An approach to developing criteria for the clinical diagnosis and classification of osteoarthritis: a status report of the American RheumatismAssociation Diagnostic Subcommittee on Osteoarthritis, J. Rheumatol. 10, 180–183.

    Google Scholar 

  • Altman, R., Asch, E., Block, E., et al. (1986). Development of criteria for the classification of osteoarthritis of the knee, Arthritis Rheum. 29, 1039–1049.

    Google Scholar 

  • Altman, R. D., Bloch, D. A., Bole, G. G., et al. (1987a). Development of clinical criteria for osteoarthritis, J. Rheumatol. 14 (Suppl.), 3–6.

    Google Scholar 

  • Altman, R. D., Fries, J. F., Bloch, D. A., et al. (1987b). Radiographic assessment of progression in osteoarthritis, Arthritis Rheum. 30, 1214–1215.

    Google Scholar 

  • Altman, R., Alacron, G., Appelrough, D., et al. (1990). The American College of Rheumatology criteria for the classification and reporting of the osteoarthritis of the hand, Arthritis Rheum. 33, 1601–1610.

    Google Scholar 

  • Altman, R., Alarcon, G., Appelrough, D., et al. (1991). The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip, Arthritis Rheum. 34, 504–514.

    Google Scholar 

  • Altman, R. D., Hochberg, M., Murphy, J. W. A., et al. (1995). Atlas of individual radiographicfeatures in osteoarthritis, Osteoarthritis Cartil. 3 (Suppl. A), 3–70.

    Google Scholar 

  • Altman, R., Brandt, K., Hochberg, M., et al. (1996). Design and conduct of clinical trials in patients with osteoarthritis, Osteoarthritis Cartil. 4, 217–243.

    Google Scholar 

  • Anderson, J. J. and Felson, D. T. (1988). Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work, Am. J. Epidemiol. 128, 179–189.

    Google Scholar 

  • Arnoldi, C. C., Linderholm, H. and Mussbichler, H. (1972). Venous engorgement and intra-osseous hypertension in osteoarthritis of the hip, J. Bone Jt. Surg. 54B, 409–421.

    Google Scholar 

  • Bazan, N. G. (2001). COX 2 as a multifunctional neuronal modulator, Nature Med. 7, 414–415.

    Google Scholar 

  • Bellamy, N., Carette, S., Ford, P., et al. (1992). Osteoarthritis anti-rheumatic drug trials, J. Rheumatol. 19, 436–457.

    Google Scholar 

  • Bellamy, N. (1999). Clinical trials design: structure modifying agents for osteoarthritis. Future guidelines: areas for development, Osteoarthritis Cartil. 7, 424–426.

    Google Scholar 

  • Blackburn Jr., W. D., Bernneuter, W. K., Rominger, M., et al. (1994). Arthroscopic evaluation of knee articular cartilage: a comparison with plain radiographs and magnetic resonance imaging, J. Rheumatol. 21, 675–679.

    Google Scholar 

  • Bland, J. H. and Cooper, S. M. (1984). Osteoarthritis: a review of the cell biology involved and evidence for reversibility, Semin. Arthritis Rheum. 14, 106–133.

    Google Scholar 

  • Boyle, J. A. and Buchanan, W. W. (1971). Clinical Rheumatology. Blackwell, Oxford.

    Google Scholar 

  • Broderick, L. S., Turner, D. A., Renfrew, D. L., et al. (1994). Severity of articular cartilage abnormality in patients with osteoarthritis: evaluation with fast spin-echo MR vs arthroscopy, Am. J. Rheum. 162, 99–103.

    Google Scholar 

  • Brooks, P., Hochberg, M., ILAR and OMERACT (2001). Outcome measures and classification criteria for the rheumatic diseases. A compilation of data from OMERACT (Outcome Measures for Arthritis Clinical Trials), ILAR (International League of Associations for Rheumatology), regional leagues and other groups, Rheumatology 40, 896–906.

    Google Scholar 

  • Buchanan, W. W. and Park, W. M. (1983). Primary generalized osteoarthritis: definition and uniformity, J. Rheumatol. 10 (Suppl. 9), 4–6.

    Google Scholar 

  • Buchanan, W. W., deCeulaer, K. and Balint, G. P. (1997). Clinical Examination of the Musculoskeletal System. Assessing Rheumatic Conditions. Williams and Wilkins, Baltimore, MD.

    Google Scholar 

  • Buchanan, W. W. and Kean, W. F. (2001). Evidence based medicine. The median is not the message, J. Rheumatol. 28, 2371–2372.

    Google Scholar 

  • Buchanan, W. W. and Kean, W. F. (2002a). Osteoarthritis: I. Epidemiological risk factors and historical considerations, Inflammopharmacology 10, 5–21.

    Google Scholar 

  • Buchanan, W. W. and Kean, W. F. (2002b). Osteoarthritis: II. Pathology and pathogenesis, Inflam-mopharmacology 10, 19–48.

    Google Scholar 

  • Buchanan, W. W. and Kean, W. F. (2002c). Osteoarthritis: III. Radiological and clinical definition, Inflammopharmacology 10, 53–78.

    Google Scholar 

  • Buchanan, W. W. and Kean, W. F. (2002d). Osteoarthritis: IV. Clinical therapeutic trials and treatment, Inflammopharmacology 10, 79–155.

    Google Scholar 

  • Buckland-Wright, J. C. (1994). Quantitative radiography of osteoarthritis, Ann. Rheum. Dis. 53, 268–275.

    Google Scholar 

  • Buckland-Wright, J. C. (1995). Protocols for precise radio-anatomical positioningof the tibio-femoral and patello-femoral compartments of the knee, Osteoarthritis Cartil. 3 (Suppl. A), 71–80.

    Google Scholar 

  • Buckland-Wright, J. C., MacFarlane, D. G. and Lynch, J. A. (1991). Quantitative microfocal radiographic assessment of disease and progression in osteoarthritis of the hand, J. Rheumatol. 18 (Suppl. 27), 40–41.

    Google Scholar 

  • Buckland-Wright, J. C., MacFarlane, D. G. and Lynch, J. A. (1992). Relationship between joint space width and subchondral sclerosis in the osteoarthritic hand: a quantitative microfocal radiographic study, J. Rheumatol. 19, 788–795.

    Google Scholar 

  • Buckland-Wright, J. C., MacFarlane, D. G. and Lynch, J. A. (1994). Quantitative microfocal radiographic assessment of osteoarthritis of the knee from weight-bearing tunnel and semi-flexed standing views, J. Rheumatol. 21, 1734–1741.

    Google Scholar 

  • Buckland-Wright, J. C., MacFarlane, D. G., Lynch, J. A., Jasani, M. K., Bradshaw, C. R. (1995). Joint space width measures cartilage thickness in osteoarthritis of the knee: high resolution plain film and double contrast macroradiographic investigation, Ann. Rheum. Dis. 54, 263–268.

    Google Scholar 

  • Burnett, S., Hart, D. J., Cooper, C. and Spector, T. D. (Eds) (1994). In: A Radiographic Atlas of Osteoarthritis, pp. 1–45. Springer, London.

    Google Scholar 

  • Burnstein, D., Gray, M. L., Hartman, A. L., et al. (1993). Diffusion of small solutes in cartilage as measured by nuclear magnetic resonance (NMR) spectroscopy and imaging, J. Orthoped. Res. II, 465–478.

    Google Scholar 

  • Butler, W. J., Hawthorne, V. M., Mikkelsen, W. M., et al. (1988). Prevalence of radiologicallydefined osteoarthritis in the finger and wrist joints of adult residents of Tecumseh, Michigan, 1962–65, J. Clin. Epidemiol. 41, 467–473.

    Google Scholar 

  • Butler, D., Trafimow, J. H., Andersson, C. B. J., et al. (1989). Disc degenerate before facets, Spine 15, 111–113.

    Google Scholar 

  • Carman, W. J. (1989). Factors associated with pain and osteoarthritis in the Tecumseh Community Health Study, Semin. Arthritis Rheum. 18 (Suppl. 2), 10–13.

    Google Scholar 

  • Chan, W. P., Lang, P., Stevens, M. P., et al. (1991). Osteoarthritis of the knee: comparison of radiography, CT, and MR imaging to assess extent and severity of, Am. J. Rheum. 157, 799–806.

    Google Scholar 

  • Chhem, R. K. (1994). Advantages and limitations of ultrasound in the evaluation of the rheumatoid shoulder. Editorial, J. Rheumatol. 21, 1591–1592.

    Google Scholar 

  • Choy, E. H. S. and Panayi, G. S. (2001). Cytokine pathways and joint in' ammation in rheumatoid arthritis, N. Engl. J. Med. 344, 907–916.

    Google Scholar 

  • Chrisman, O. D., Ladenbauer-Bellis, I. M., Panjabi, M., et al. (1981). The relationship of mechanical trauma and the early biochemical reactions of osteoarthritis cartilage, Clin. Orthoped. 161, 275–284.

    Google Scholar 

  • Cicuttini, F. M., Wluka, A., Forbes, A., et al. (2003). Comparison of tibial cartilage volume and radiologic grade of the tibiofemoral joint, Arthritis Rheum. 48, 682–688.

    Google Scholar 

  • Conrozier, T., Tron, A. M. and Vignon, E. (1995). Quantitative assessment of radiographic normal and osteoarthritic hip joint space, Osteoarthritis Cartil. 3 (Suppl. A), 81–88.

    Google Scholar 

  • Cooper, C., Cushnaghan, J., Krwan, J. R., et al. (1992). Radiographic assessment of the knee joint in osteoarthritis, Ann. Rheum. Dis. 51, 80–82.

    Google Scholar 

  • Cooper, C. (1998). Osteoarthritis and related disorders, in: Epidemiology in Rheumatology, Klippel, J. H. and Dieppe, P. A. (Eds), second edition, pp. 2.0–2.8. Mosby, London.

  • Crain, D. C. (1961). Interphalangeal osteoarthritis characterized by painful inflammatory episodes resulting in deformity of the proximal and distal articulations, J. Am. Med. Ass. 175, 1049–1053.

    Google Scholar 

  • Croft, P., Cooper, C., Wickham, C., et al. (1990). Defining osteoarthritis of the hip for epidemiologic studies, Clin. J. Epidemiol. 132, 514–522.

    Google Scholar 

  • Cushnagham, J. and Dieppe, P. A. (1991). A study of 500 patients with limb joint osteoarthritis I. Analysis by age, sex and distribution of symptomatic joint sites, Ann. Rheum. Dis. 50, 8–13.

    Google Scholar 

  • Danielsson, L. G. (1964). Incidence and prognosis of cox arthrosis, Acta Orthoped. Scand. 1 (Suppl.), 1–87.

    Google Scholar 

  • Dieppe, P. A. (1995). Recommended methodology for assessing the progression of osteoarthritis of the hip and knee joints, Osteoarthritis Cartil. 3, 73–77.

    Google Scholar 

  • Dieppe, P., Cushnaghan, J., Young, P., et al. (1993). Prediction of the progression of joint space narrowing in osteoarthritis of the knee by bone scintigraphy, Ann. Rheum. Dis. 52, 557–563.

    Google Scholar 

  • Disler, D. G., McCauley, T. R., Wirth, C. R., et al. (1995). Detection of knee hyaline articular cartilage defects using fat-suppressed three-dimensional spoiled gradient-echo MR imaging: comparison with standard MR imaging and correlation with arthroscopy, Am. J. Rheumatol. 165, 377–382.

    Google Scholar 

  • Dougados, M., Gueguen, A., Nguyen, M., et al. (1992). Longitudinal radiologic evaluation of osteoarthritis of the knee, J. Rheumatol. 19, 378–384.

    Google Scholar 

  • Dougados, M. (1996). Recommendations for the registration of drugs used in the treatment of osteoarthritis, Am. Rheum. Dis. 55, 552–557.

    Google Scholar 

  • Ehrlich, G. E. (1972a). Inflammatory osteoarthritis I. The clinical syndrome, J. Chronic Dis. 25, 317–328.

    Google Scholar 

  • Ehrlich, G. E. (1972b). Inflammatory osteoarthritis II. The superimposition of rheumatoid arthritis, J. Chronic Dis. 25, 635–643.

    Google Scholar 

  • Ehrlich, G. E. (1975). Osteoarthritisbeginning with inflammation. Definitions and correlations, J. Am. Med. Ass. 232, 157–159.

    Google Scholar 

  • Felson, D. T. (1988). Epidemiology of hip and knee osteoarthritis, Epidemiol. Rev. 10, 1–28.

    Google Scholar 

  • Felson, D. T. (1993). The course of osteoarthritis and factors that affect it, Rheum. Dis. Clin. North Am. 19, 607–615.

    Google Scholar 

  • Felson, D. T. (1998). Epidemiology of osteoarthritis, in: Osteoarthritis, Brandt, K. D., Lohmander, L. S. and Doherty, M. (Eds), pp. 13–22. Oxford University Press, Oxford.

    Google Scholar 

  • Ficat, P. and Hungerford, D. S. (1977). Disorders of the Patello-Femoral Joint. Williams and Wilkins, Baltimore, MD.

    Google Scholar 

  • Fife, R. S., Brant, K. D., Braunstein, E. M., et al. (1991). Relationship between arthroscopic evidence of cartilage damage and radiographic evidence of joint space narrowing in early osteoarthritis of the knee, Arthritis Rheum. 34, 377–382.

    Google Scholar 

  • Földes, K., Bálint, P., Gaal, M., et al. (1992). Nocturnal pain correlates with effusions in diseased hips, J. Rheumatol. 19, 1756–1758.

    Google Scholar 

  • Forrest, J. B. (1992). Sympathetic mechanisms in post operative pain, Can. J. Anaesthesiol. 39, 523–527.

    Google Scholar 

  • Forrest, J. B. (Ed.) (1998). Pathophysiology of acute pain, in: Acute Pain: Pathophysiology and Treatment, pp. 31–65. Manticore, Grimsby, ON.

  • Frymoyer, J. W., Newberg, A., Pope, M. H., et al. (1984). Spine radiographs in patients with low back pain: an epidemiological study in man, J. Bone Jt. Surg. 66A, 1048–1055.

    Google Scholar 

  • Goodfellow, J. W., Hungerford, D. S. and Woods, C. (1976). Patello-femoral mechanism and pathology II. Chondromalacia patellae, J. Bone Jt. Surg. 58B, 291–299.

    Google Scholar 

  • Greenspan, A. (1992). Degenerative joint disease, in: Orthopedic Radiology: A Practical Approach

  • Greenspan, A. and Chapman, M. W. (Eds), 2nd edition, Chapter 12, pp. 1–20. Raven Press, New York, NY.

  • Greenspan, A., Normal, A. and Tchang, K. F. (1977). “Tooth” sign in patellar degenerative disease, J. Bone Jt. Surg. 59A, 483–485.

    Google Scholar 

  • Greenway, G., Resnick, D., Weisman, M., et al. (1979). Carpal involvement in inflammatory (erosive) osteoarthritis, J. Can. Ass. Radiol. 30, 95–98.

    Google Scholar 

  • Halverson, P. B., Carbera, G. F. and McCarty, D. J. (1990). Milwaukee shoulder syndrome. Fifteen additional cases and a description of contributing factors, Arch. Int. Med. 150, 677–682.

    Google Scholar 

  • Halverson, P. B., McCarty, D. J., Cheung, H. S., et al. (1984). Milwaukee shoulder syndrome: eleven additional cases with involvement of the knee in seven (bone calciumphosphate crystal deposition disease). Semin. Arthritis Rheum. 14, 36–44.

    Google Scholar 

  • Hart, D. J. and Spector, T. D. (1995). Radiographic criteria for epidemiological studies of OA, J. Rheumatol. 22 (Suppl. 43), 46–48.

    Google Scholar 

  • Hernborg, J. and Nilsson, B. E. (1973). The relationship between osteophytes in the knee joint, osteoarthritis and aging, Acta Orthoped. Scand. 44, 69–74.

    Google Scholar 

  • Hernborg, J. and Nilsson, B. E. (1977). The natural course of untreated osteoarthritis of the knee, Clin. Orthoped. 123, 130–137.

    Google Scholar 

  • Hill, C. L., Gale, D. R., Chaisson, C. E., et al. (2003). Periarticular lesions detected on magnetic resonance imaging: prevalence in knees with and without symptoms, Arthritis Rheum. 48, 2836–2844.

    Google Scholar 

  • Hutton, C. W., Higgs, E. R., Jackson, P. C., et al. (1986). 99m Tc-HMDP bone scanning in generalized osteoarthritis in the four hour bone scan image predicts radiographicchange, Ann. Rheum. Dis. 45, 622–626.

    Google Scholar 

  • Hwang, W. S., Li, B., Jin, J. H., et al. (1992). Collagen febrile structure of normal, aging, and osteoarthritic cartilage, J. Pathol. 167, 425–433.

    Google Scholar 

  • Iagnocco, A., Coari, G. and Zoppini, A. (1992). Sonographic evaluation of femoral condylar cartilage in osteoarthritis and rheumatoid arthritis, Scand. J. Rheum. 21, 210–203.

    Google Scholar 

  • Jones, A. E., Ledinham, J., McAlindon, T., et al. (1993). Radiographic assessment of patellofemoral osteoarthritis, Ann. Rheum. Dis. 52, 655–658.

    Google Scholar 

  • Kallman, D. A., Wigley, F. M., Scott, W. W. J., et al. (1989). New radiographic grading scales for osteoarthritis of the hand: reliability for determining prevalence and progression, Arthritis Rheum. 32, 1584–1591.

    Google Scholar 

  • Kaye, J. J. (1993). Radiographic assessment of osteoarthritis: new techniques, Rheum. Dis. Clin. North Am. 19, 659–672.

    Google Scholar 

  • Kean, W. F., Buchanan, W. W. and Kean, R. (2003). Osteoarthritis: symptoms and signs, Inflam-mopharmacology 11, 481–482.

    Google Scholar 

  • Kellgren, J. H. and Lawrence, J. S. (1957). Radiological assessment of osteoarthritis, Ann. Rheum. Dis. 16, 494–501.

    Google Scholar 

  • Kellgren, J. H. and Moore, R. (1952). Generalized osteoarthritis and Heberden's nodes, Br. Med. J. 1, 181–187.

    Google Scholar 

  • Kellgren, J. H., Jeffery, M. and Ball, J. (1963). Atlas of Standard Radiographs. Blackwell, Oxford.

    Google Scholar 

  • Kellgren, J. H., Lawrence, J. S. and Bier, F. (1963). Genetic factors in generalized osteoarthritis, Ann. Rheum. Dis. 22, 237–355.

    Google Scholar 

  • Kidd, K. L. and Peter, J.B. (1966). Erosive osteoarthritis, Arthritis Rheum. 9, 365–388.

    Google Scholar 

  • Kimball, E. S., Persico, F. J. and Vaught, J. L. (1988). Substance P., neurokinin A and neurokinin B induce generation of Il-1 like activity in P388D1 cells, Possible relevance to arthritic disease, J. Immunol. 141, 3564–3569.

    Google Scholar 

  • Konttinen, Y. T., Kemppinen, P., Segerberg, M., et al. (1994). Peripheral and spinal neural mechanisms in arthritis, with particular reference to treatment of inflammation and pain, Arthritis Rheum. 37, 965–982.

    Google Scholar 

  • Kusaka, Y., Grunder, W., Rumpel, H., et al. (1992). MR microimaging of articular cartilage and contrast enhancement by manganese ions, Magn. Reson. Med. 24, 137–148.

    Google Scholar 

  • Lachance, L., Sowers, M., Jamadar, D., et al. (2001). The experience of pain and emergent osteoarthritis of the knee, Osteoarthritis Cartil. 9, 527–532.

    Google Scholar 

  • Lane, N. E., Nevitt, M. C., Genant, H. K., et al. (1993). Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration, J. Rheumatol. 20, 1911–1918.

    Google Scholar 

  • Lawrence, J. S. (1977). Rheumatism in Populations. Heinemann, London.

    Google Scholar 

  • Lawrence, J. S. and Sebo, M. (1980). The geography of osteoarthritis, in: Aetiopathogensis of Osteoarthritis, Nuki, G. (Ed.), pp. 155–183. Pitman, London.

    Google Scholar 

  • Lawrence, R. C., Helmick, C. G., Arnett, F. C., et al. (1988). Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States, Arthritis Rheum. 41, 778–799.

    Google Scholar 

  • Leach, R. E., Gregg, T. and Siber, F. J. (1970). Weight-bearing radiography in osteoarthritis of the knee, Radiology 97, 265–268.

    Google Scholar 

  • Ledingham, J., Dawson, S., Milligan G., et al. (1993). Radiographic progression of hospital referred osteoarthritis of the hip, Ann. Rheum. Dis. 54, 263–267.

    Google Scholar 

  • Lesperance, L. M., Gray, M. L. and Burnstein, D. (1992). Determination of fixed charged density in cartilage using nuclear magnetic resonance, J. Orthoped. Res. 10, 1–13.

    Google Scholar 

  • Lim, K., Rogers, J., Shepstone, L., et al. (1995). The evolutionary origins of osteoarthritis: a comparative skeletal study of hand disease in 2 primates, J. Rheumatol. 22, 2132–2134.

    Google Scholar 

  • Lindblad, S. (1989). Arthroscopic and synovial correlates of pain in osteoarthritis, Semin. Arthritis Rheum. 18 (Suppl. 2), 91–93.

    Google Scholar 

  • Littlejohn, G. O. and Smythe, H. A. (1981). Marked hyperinsulinemia after glucose challenge in patients with diffuse idiopathic skeletal hyperostosis, J. Rheumatol. 8, 965–968.

    Google Scholar 

  • Lynch, J. A., Buckland-Wright, C. and MacFarlane, D. G. (1993). Precision of joint space width measurement in knee OA from digital image analysis of high definition radiographs, Osteoarthritis Cartil. 1, 209–218.

    Google Scholar 

  • Mangieri, J. V. (1973). Peroneal nerve injury froman enlarged fabella. A case report, J. Bone Jt. Surg. 55A, 395–397.

    Google Scholar 

  • Mankin, H. J. (1983). Speculation regarding biochemical pathogenesis of generalized osteoarthritis, J. Rheumatol. 10 (Suppl. 9), 7–8.

    Google Scholar 

  • Marmor, L. and Peter, J. B. (1969). Osteoarthritis of the hand, Clin. Orthoped. Relat. Res. 64, 164–174.

    Google Scholar 

  • Matucci-Cerinic, M., Lombardi, A., Leoncini, G., et al. (1993). Neutral endopeptidase (3,4,24,11) in plasma and synovial fluid of patients with rheumatoid arthritis. A marker of disease activity or a regulator of pain and inflammation?, Rheumatol. Int. 13, 1–4.

    Google Scholar 

  • Mazzuca, S. A. and Brandt, K. D. (1999). Plain radiography as an outcome measure in clinical trials involving patients with knee osteoarthritis, Rheum. Dis. Clin. North Am. 25, 467–480.

    Google Scholar 

  • Mazzuca, S. A., Brandt, K. D. and Buckwalter, K. A. (2003). Detection of radiographic joint space narrowing in subjects with knee osteoarthritis, Arthritis Rheum. 48, 385–389.

    Google Scholar 

  • McAlindon, T. and Dieppe, P. (1989). Osteoarthritis definitions and criteria, Ann. Rheum. Dis. 48, 531–532.

    Google Scholar 

  • McAlindon, T. E., McCrae, F., Watt, I., et al. (1991). Magnetic resonance imaging in osteoarthritis of the knee: correlation with clinical radiographic, and scintigraphic appearances, Ann. Rheum. Dis. 50, 14–19.

    Google Scholar 

  • McCarty, D. J., Halverson, P. B., Carrera, G. F., et al. (1981a). “Milwaukee shoulder” —associationof microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects II. Synovial fluid studies, Arthritis Rheum. 24, 474–483.

    Google Scholar 

  • McCarty, D. J., Halverson, P. B., Carrera, G. F., et al. (1981b). “Milwaukee shoulder” — association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects III. Morpologic and biochemical studies of an excised synovium showing chondromatosis, Arthritis Rheum. 24, 484–491.

    Google Scholar 

  • McCrae, F., Shoels, J., Dieppe, P., et al. (1992). Scintigraphic assessment of osteoarthritis of the knee joint, Ann. Rheum. Dis. 51, 938–942.

    Google Scholar 

  • McEwan, C. (1968). Osteoarthritis of the fingers with ankylosis, Arthritis Rheum. 11, 734–744.

    Google Scholar 

  • McGibbon, C. A. (2003). Inter-rater and intra-rater reliability of subchondral bone and cartilage thickness measurement from MRI, Magn. Reson. Imag. 21, 707–714.

    Google Scholar 

  • Meachin, G. and Emery, I. H. (1947). Quantitative aspects of patello-femoral cartilage fibrillation in Liverpool necropsies, Ann. Rheum. Dis. 33, 39–47.

    Google Scholar 

  • Menkes, C. J., Renaux, M., Laoussadi, S., et al. (1993). Substance P levels in the synovium and synovial fluid from patients with rheumatoid arthritis and osteoarthritis, J. Rheumatol. 20, 714–717.

    Google Scholar 

  • Myers, S. L., Dines, K., Brandt, D. A., et al. (1995). Experimental assessment by high frequency ultrasound of articular cartilage thickness and osteoarthritic changes, J. Rheumatol. 22, 109–116.

    Google Scholar 

  • Oegema, T. R. (1991). The inter-relationshipof facet joint osteoarthritis and degenerativedisc disease, Br. J. Rheum. 30 (Suppl. 1), 16–20.

    Google Scholar 

  • Patel, D. (1978). Arthroscopy of the plicae —synovial folds and their significance, Am. J. Sports Med. 6, 217–225.

    Google Scholar 

  • Pelletier, J.-P., Caron, J. P., Evans, C., et al. (1997). In vivo suppression of early experimental osteoarthritis by interleukin-1 receptor antagonist using gene therapy, Arthritis Rheum. 40, 1012–1019.

    Google Scholar 

  • Pelletier, J.-P. and Martel-Pelletier, J. (2003). Therapeutic targets in osteoarthritis: from today to tomorrow with new imaging technology, Ann. Rheum. Dis. 62, 79–82.

    Google Scholar 

  • Peter, J. B., Pearson, C. M. and Marmor, L. (1966). Erosive osteoarthritis of the hands, Arthritis Rheum. 9, 365–388.

    Google Scholar 

  • Petersson, C. J. and Redlund-Johnell, I. (1984). The subacromial space in normal shoulder radi-ographs, Acta Orthoped. Scand. 55, 57–58.

    Google Scholar 

  • Peterfy, C. G. and Genant, H. K. (1996). Emerging applications of magnetic resonance imaging for evaluating the articular cartilage, Radiol. Clin. North Am. 34, 195–213.

    Google Scholar 

  • Peterfy, C. G., Majumdar, S., Lang, P., et al. (1994). MR imaging of the arthritic knee: improved discrimination of cartilage, synovium and effusion with pulsed saturation transfer and fat-suppressed T1-weighted sequences, Radiology 191, 413–419.

    Google Scholar 

  • Peterfy, C. G., van Dijke, C. F., Lu, Y., et al. (1995). Quantification of articular cartilage in the metacarpophalangealjoints of the hand: accuracy and precision of three-dimensionalMR imaging. Am. J. Rontgenol. 165, 371–375.

    Google Scholar 

  • Pham, T., Van Der Heijde, D., Lassere, M., et al. (2003). OMERACT-OARSI. Outcome variables for osteoarthritis clinical trials: The OMERACT-OARSI set of responder criteria, J. Rheumatol. 7, 1648–1654.

    Google Scholar 

  • Phillips, R. S., Bulmar, J. H., Hoyle, G., et al. (1967). Venous drainage in osteoarthritis of the hip. A study after osteotomy, J. Bone Jt. Surg. 49B, 301–309.

    Google Scholar 

  • Pilch, L., Stewart, C., Gordon, D., et al. (1994). Assessment of cartilage volume in the femoral tibial joint with magnetic resonance imaging and 3D computer reconstruction, J. Rheumatol. 21, 2307–2319.

    Google Scholar 

  • Pridie, K. N. (1959). A method of resurfacing osteoarthritis knee joints, J. Bone Jt. Surg. 41B, 618–619.

    Google Scholar 

  • Quinn, S. F., Rose, P. M., Brown, T. R., et al. (1994). MR imaging of the patellofemoral compartment MRI, Clin. North Am. 2, 425–439.

    Google Scholar 

  • Radin, E. L. (1985). Anterior knee pain, need for a specific diagnosis, Orthoped. Rev. 14, 128–134.

    Google Scholar 

  • Recht, M. P., Kramer, J., Marcelis, S., et al. (1993). Abnormalities of articular cartilage in the knee: analysis of available MR techniques, Radiology 187, 473–478.

    Google Scholar 

  • Repo, R. U. and Findlay, J. B. (1977). Survival of cartilage after controlled impact, J. Bone Jt Surg. 59A, 1068–1076.

    Google Scholar 

  • Rivaud, P., Auerling, G.-R., Chaslang, C., et al. (1996a). Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning, Br. J. Rheumatol. 35, 761–766.

    Google Scholar 

  • Rivaud, P., Buckland-Wright, J. C., Hochberg, H. C., iet al. (1996b). Quantitative radiography in osteoarthritis, Clin. Rheumatol. 10, 409–434.

    Google Scholar 

  • Resnick, D. and Vint, V. (1980). The “tunnel” view in assessment of cartilage loss in osteoarthritis of the knee, Radiology 137, 547–548.

    Google Scholar 

  • Rogers, J., Watt, I. and Dieppe, P. (1990). Comparison of visual and radiographic detection of bony changes at the knee joint, Br. Med. J. 300, 367–368.

    Google Scholar 

  • Rose, P. M., Demlow, T. A., Szumowski, J., et al. (1994). Chondromalacia patellae: fat-suppressed MR imaging, Radiology 193, 437–440.

    Google Scholar 

  • Rutten, M. J. C. N., Collins, J. M. P., van Kampen, A., et al. (1998). Meniscal cysts: Detection with high resolution sonography, Am. J. Rontgenol. 171, 491–496.

    Google Scholar 

  • Sharif, M., George, E., Shepstone, L., et al. (1995a). Serum hyaluronic acid level as a predictor of disease progression in osteoarthritis of the knee, Arthritis Rheum. 38, 760–767.

    Google Scholar 

  • Sharif, M., Saxne, T., Shepstone, L., et al. (1995b). Relationship between serum cartilage oligomeric matrix protein levels and disease progression in osteoarthritis of the knee joint, Br. J. Rheumatol. 34, 306–310.

    Google Scholar 

  • Smukler, N. M., Edeiken, J. and Giuliano, V. J. (1971). Ankylosis in osteoarthritis of the finger joints, Radiology 100, 525–530.

    Google Scholar 

  • Spector, T. D. and Cooper, C. (1993). Radiographic assessment of osteoarthritis in population studies: whither Kellgren and Lawrence?, Osteoarthritis Cartil. 1, 203–206.

    Google Scholar 

  • Spector, T. D., Hart, D. J., Byrne, J., et al. (1993). Definition of osteoarthritis of the knee for epidemiological studies, Ann. Rheum. Dis. 52, 790–794.

    Google Scholar 

  • Stecher, R. M. (1946). Heberden's nodes. Their relation to other degenerative joint diseases, Arch. Phys. Med. Rehab. 27, 409–413.

    Google Scholar 

  • Summers, M. N., Haley, W. E., Reveille, J. O., et al. (1988). Radiographic assessment and psychological variables as predictors of pain and functional improvement in osteoarthritis of the knee or hip, Arthritis Rheum. 31, 204–209.

    Google Scholar 

  • Theiler, R., Ghosh, P. and Brooks, P. (1994). Clinical, biochemical and imaging methods of assessing osteoarthritis and clinical trials with agents claiming “chondromodulating” activity. Osteoarthritis Cartil. 2, 1–23.

    Google Scholar 

  • Thomas, R. H., Resnick, D., Alazraki, N. P., et al. (1975). Compartmental evaluation of osteoarthritis of the knee, Radiology 116, 565–594.

    Google Scholar 

  • Utsinger, P. D., Resnick, D., Shapiro, R. F., et al. (1978). Roentgenologic, immunologic and therapeutic study of erosive (inflammatory) osteoarthritis, Arch. Int. Med. 138, 693–697.

    Google Scholar 

  • Van Saase, J. L. C., van Romunde, L. K. J., Cats, A., et al. (1989). Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that of 10 other populations, Ann. Rheum. Dis. 48, 271–280.

    Google Scholar 

  • Vernon-Roberts, B. and Pirie, C. J. (1977). Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae, Rheumatol Rehabil. 16, 13–21.

    Google Scholar 

  • Vignon, E., Piperno, M., Le Graverand, M.-P., et al. (2003). High resolution ultrasound detects synovitis in the majority of patients with knee osteoarthritic knee, Arthritis Rheum. 48, 378–384.

    Google Scholar 

  • Wakefield, R. J., Gibbon, W. W., O'Connor, P., et al. (1998). High resolution ultrasound detects synovitis in the majority of patients with knee osteoarthritis, Arthritis Rheum. 41, S146.

    Google Scholar 

  • Wakefield, R. J., Gibbon, W. W. and Emery, P. (1999). The current status of ultrasonography in rheumatology, Rheumatology 38, 195–198.

    Google Scholar 

  • Waldschmidt, J. G., Bruanstein, E. M. and Buckwalter, K. A. (1999). Magnetic resonance imaging of osteoarthritis, Rheum. Dis. Clin. North Am. 25, 451–465.

    Google Scholar 

  • Yazici, H., Saville, P. D., Salvati, E. A., et al. (1975). Primary osteoarthritis of the knee or hip. Prevalence of Heberden's nodes in relation to age and sex, J. Am. Med. Ass. 231, 1256–1260.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kean, W.F., Kean, R. & Buchanan, W.W. Osteoarthritis: symptoms, signs and source of pain. Inflammopharmacology 12, 3–31 (2004). https://doi.org/10.1163/156856004773121347

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1163/156856004773121347

  • OSTEOARTHRITIS
  • PAIN
  • X-RAY
  • IMAGING
  • CLINICAL TRIALS