Cartilage metabolism in osteoarthritis and the influence of viscosupplementation and steroid: a review

Abstract

Osteoarthritis (O.A.) is the most common type of articular disease. This is an idiopathic joint disease characterized by an imbalance between synthesis and degradation of articular cartilage and subchondral bone accompanied by capsular fibrosis, osteophyte formation and variable grade of inflammation of synovial membrane. Joint lubrication is naturally provided by Hyaluronic acid in syovial fluid. Hyaluronan is present in abundance in normal young and healthy joints. In degenerative O.A. Hyaluronan is smaller in size, molecular weight and diminished in concentration. This decrease in joint lubrication and shock absorbing mechanism in O.A. can be remedied by intraarticular viscosupplementation. Alternatively the pain and secondary inflammation in O.A. can be relieved by intraarticular injection of steroids and long acting local anesthetics. Promt and effective reduction in local inflammation occurs after intra-articular injection of corticosteriod. This article reviews the cartilage metabolism in O.A., discusses the pros and cons of these treatments and provides a literature review of the studies which compare benefits and adverse reactions of viscosupplementation vs. intraarticular steroids with placebo treatment.