The Symptoms of Osteoarthritis and the Genesis of Pain

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Symptomatic osteoarthritis (OA) causes substantial physical and psychosocial disability. This article delineates the characteristic symptoms and signs associated with OA and how they can be used to make the clinical diagnosis. The predominant symptom in most patients is pain. The remainder of the article focuses on what is known about the causes of pain in OA and factors that contribute to its severity. Much has been learned during recent years, but much of this puzzle remains unexplored or inadequately understood.

Section snippets

What is osteoarthritis?

OA can be viewed as the clinical and pathologic outcome of a range of disorders that result in structural and functional failure of synovial joints [5]. OA occurs when the dynamic equilibrium between the breakdown and repair of joint tissues is overwhelmed [6]. This progressive joint failure may cause pain, physical disability, and psychologic distress [1], although many persons who have structural changes consistent with OA are asymptomatic [7]. The reasons for this lack of correlation between

Factors that contribute to pain

The source of pain in OA is not well understood and is best considered in a biopsychosocial framework that posits that biologic, psychologic, and social factors all play a significant role in pain in OA [21]. The schematic in Fig. 1 depicts some of this complexity.

From a biologic perspective, neuronal activity in the pain pathway is responsible for the generation and ultimate exacerbation of the feeling of joint pain. During inflammation, chemical mediators are released into the joint that

Summary

The pathophysiology of pain in OA is complex, and, similarly, the symptomatic presentation in OA is diverse and heterogeneous. Attention to the many modulating factors that alter the experience of pain may improve the way this disease is treated.

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    In the preparation of this article Dr. Keefe was supported in part by NIH grants: AG026010, AR47218, AR049059, AR050245, and AR05462. Dr. Hunter receives research or institutional support from AstraZeneca, DonJoy, Lilly, Merck, National Institutes of Health, Pfizer, Stryker, and Wyeth.

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