General Principles and Approach to the Patient in the Context of Osteoarthritis

Abstract

Osteoarthritis has a venerable history, having been recorded in Egyptian mummies and in dinosaurs of the Pleistocene era. It is now obvious that the term osteoarthritis represents a syndrome, not a disease. Furthermore the term means different things to different people. To the pathologist it implies fibrillation and destruction of the cartilage surface with clustering of chondrocytes around the bases of deep clefts, remodelling and sclerosis of subchondral bone, changes in the composition and characteristics of synovial fluid and the development of marginal osteophytes. To the radiologist the word suggests loss of joint “space” (reflecting cartilage destruction), osteophytosis, bone cysts and increased density of subchondral bone. To the clinician the word conjures up a picture of a very common clinical problem where the patient complains of pain more than stiffness, and of functional disability but where the disease process is confined essentially to one or to a few affected joints.