Epidemiology and pathogenesis of osteoarthritis

초록

Background: Osteoarthritis (OA) is the most common form of arthritis and poses a considerable socioeconomic burden, contributing to disability and decreased quality of life, particularly in older adults. However, the current treatment for OA is limited to pain relief, and it is necessary to develop disease-modifying OA drugs that target specific molecular mechanisms of its pathogenesis. Current Concepts: The prevalence of OA increases with age, with the incidence being higher in individuals aged over 60 years. Furthermore, women are more likely to develop knee and hand OA, whereas hip OA is more common in men. The global burden of OA is increasing, driven by an aging population and increasing obesity. The main pathological feature of OA is the degradation of the cartilage extracellular matrix by catabolic proteases such as matrix metalloproteinase 13 (MMP13) and a disintegrin and metalloproteinase with thrombospondin motifs 5 (Adamts5), which are regulated by various signaling pathways and transcription factors. The metabolic shift towards glycolysis, which is associated with mitochondrial dysfunction, increases oxidative stress, ultimately leading to chondrocyte senescence and apoptosis. Chondrocytes in the superficial zone have stem cell-like properties and secrete anabolic proteins such as lubricin and fibulin-3. Subchondral bone remodeling and chondrocyte senescence have emerged as critical mechanisms of OA progression. Discussion and Conclusion: The understanding of OA has markedly evolved in recent years, shifting from the traditional view of OA as a "wear and tear" disease to a multifaceted condition with a complex pathogenesis. This paradigm shift could contribute to the development of novel strategies to halt OA progression.

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