The symptoms of osteoarthritis and the genesis of pain.

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 we know causes pain in OA and contributes to its severity. Much has been learned over recent years; however, for the budding researcher much of this puzzle remains unexplored or inadequately understood.

[1]  J. McDougall,et al.  Gabapentin reduces the mechanosensitivity of fine afferent nerve fibres in normal and inflamed rat knee joints , 2003, Pain.

[2]  Anthony K. P. Jones,et al.  The cortical representation of pain , 1999, PAIN.

[3]  Adam Sapirstein,et al.  Interleukin-1β-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity , 2001, Nature.

[4]  J. McDougall,et al.  Loss of vasomotor responsiveness to the mu-opioid receptor ligand endomorphin-1 in adjuvant monoarthritic rat knee joints. , 2004, American journal of physiology. Regulatory, integrative and comparative physiology.

[5]  H. Schaible,et al.  Discharge characteristics of sympathetic efferents to the knee joint of the cat. , 1987, Journal of the autonomic nervous system.

[6]  S. Santavirta,et al.  Peripheral and spinal neural mechanisms in arthritis, with particular reference to treatment of inflammation and pain. , 1994, Arthritis and rheumatism.

[7]  J. McDougall,et al.  The role of joint nerves and mast cells in the alteration of vasoactive intestinal peptide (VIP) sensitivity during inflammation progression in rats , 2005, British journal of pharmacology.

[8]  T. Aigner,et al.  Pathobiology of osteoarthritis: pathomechanisms and potential therapeutic targets. , 2007, Current drug targets.

[9]  J. McDougall,et al.  Cannabinoid-mediated antinociception is enhanced in rat osteoarthritic knees. , 2008, Arthritis and rheumatism.

[10]  C. E. Goodman Pathophysiology of pain. , 1983, Archives of internal medicine.

[11]  M. Johnston,et al.  Cognitive representations of illness and functional and affective adjustment following surgery for osteoarthritis. , 1998, Social science & medicine.

[12]  R. Kane,et al.  Efforts to standardize the reporting of pain. , 2002, Journal of clinical epidemiology.

[13]  B. Penninx,et al.  Direct and buffer effects of social support and personal coping resources in individuals with arthritis. , 1997, Social science & medicine.

[14]  R. Schwartzman,et al.  Neuropathic central pain: epidemiology, etiology, and treatment options. , 2001, Archives of neurology.

[15]  Y. Matsusue,et al.  Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids , 2003, Annals of the rheumatic diseases.

[16]  P. Roland Cortical representation of pain , 1992, Trends in Neurosciences.

[17]  D. Baucom,et al.  Spouse-assisted coping skills training in the management of osteoarthritic knee pain. , 1996, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[18]  H. Schaible,et al.  Pathophysiology and treatment of pain in joint disease. , 2006, Advanced drug delivery reviews.

[19]  R. Panush,et al.  Is running associated with degenerative joint disease? , 1986, JAMA.

[20]  L Alfredsson,et al.  Occupation and osteoarthrosis of the hip and knee: a register-based cohort study. , 1991, International journal of epidemiology.

[21]  D. Baucom,et al.  Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. , 1999, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[22]  A. Basbaum Spinal mechanisms of acute and persistent pain. , 1999, Regional anesthesia and pain medicine.

[23]  T. Vail,et al.  A comparative assessment of alignment angle of the knee by radiographic and physical examination methods. , 2005, Arthritis and rheumatism.

[24]  H. Schaible,et al.  Effects of an experimental arthritis on the sensory properties of fine articular afferent units. , 1985 .

[25]  J. Djurhuus,et al.  Intraosseous phlebography, intraosseous pressure measurements and 99mTC-polyphosphate scintigraphy in patients with various painful conditions in the hip and knee. , 1980, Acta orthopaedica Scandinavica.

[26]  C. Bombardier,et al.  Osteoarthritis of the hip and knee and mechanical occupational exposure--a systematic overview of the evidence. , 1997, The Journal of rheumatology.

[27]  D. Burr,et al.  The importance of subchondral bone in the progression of osteoarthritis. , 2004, The Journal of rheumatology. Supplement.

[28]  D. Felson,et al.  An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. , 1998, Arthritis and rheumatism.

[29]  J. Hunter,et al.  The Prevalence of Degenerative Arthritis of the Base of the Thumb in Post-Menopausal Women , 1994, Journal of hand surgery.

[30]  R. Moskowitz,et al.  Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. , 1986, Arthritis and rheumatism.

[31]  D Coggon,et al.  Osteoarthritis of the hip and occupational activity. , 1992, Scandinavian journal of work, environment & health.

[32]  P. Césaro,et al.  Pharmacology of neuropathic pain. , 1995, Clinical neuropharmacology.

[33]  J. M. Laborde,et al.  Influence of weather on osteoarthritics. , 1986, Social science & medicine.

[34]  J. McDougall,et al.  Chronic arthritis down-regulates peripheral mu-opioid receptor expression with concomitant loss of endomorphin 1 antinociception. , 2005, Arthritis and rheumatism.

[35]  J. McDougall,et al.  A role for calcitonin gene-related peptide in rabbit knee joint ligament healing. , 2000, Canadian journal of physiology and pharmacology.

[36]  S. Robbins,et al.  Vertical impact increase in middle age may explain idiopathic weight-bearing joint osteoarthritis. , 2001, Archives of physical medicine and rehabilitation.

[37]  S. Cummings,et al.  Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study. , 2002, Arthritis and rheumatism.

[38]  A. Guermazi,et al.  The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston–Leeds Osteoarthritis Knee Score) , 2007, Annals of the rheumatic diseases.

[39]  G. Nuki Osteoarthritis: a problem of joint failure , 1999, Zeitschrift für Rheumatologie.

[40]  David T Felson,et al.  Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. , 2002, American journal of epidemiology.

[41]  C. Arnoldi Vascular aspects of degenerative joint disorders. A synthesis. , 1994, Acta orthopaedica Scandinavica. Supplementum.

[42]  D. Kerrigan,et al.  Women's shoes and knee osteoarthritis , 2001, The Lancet.

[43]  M. Hurley,et al.  Sensorimotor changes and functional performance in patients with knee osteoarthritis , 1997, Annals of the rheumatic diseases.

[44]  Thomas J. Schnitzer,et al.  Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update , 2000 .

[45]  Leonie Segal,et al.  Can we reduce disease burden from osteoarthritis? , 2004, The Medical journal of Australia.

[46]  D. Eyre,et al.  Collagens and cartilage matrix homeostasis. , 2004, Clinical orthopaedics and related research.

[47]  H. Linderholm,et al.  Intraosseous hypertension and pain in the knee. , 1975, The Journal of bone and joint surgery. British volume.

[48]  R. Teitge,et al.  Synovial thickening detected by MR imaging in osteoarthritis of the knee confirmed by biopsy as synovitis. , 1995, Magnetic resonance imaging.

[49]  A. Dray,et al.  Arthritis and pain. Future targets to control osteoarthritis pain , 2007, Arthritis research & therapy.

[50]  I. Strusberg,et al.  Influence of weather conditions on rheumatic pain. , 2002, The Journal of rheumatology.

[51]  B. Wyke,et al.  The innervation of the knee joint. An anatomical and histological study in the cat. , 1967, Journal of anatomy.

[52]  P. Wolf,et al.  The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. , 1994, American journal of public health.

[53]  H. Genant,et al.  Synovitis detected on magnetic resonance imaging and its relation to pain and cartilage loss in knee osteoarthritis , 2007, Annals of the rheumatic diseases.

[54]  D. Felson The sources of pain in knee osteoarthritis , 2005, Current opinion in rheumatology.

[55]  Girish P Joshi,et al.  Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. , 2005, Anesthesiology clinics of North America.

[56]  F. Keefe,et al.  Pain Communication in the Context of Osteoarthritis: Patient and Partner Self-efficacy for Pain Communication and Holding Back from Discussion of Pain and Arthritis-related Concerns , 2008, The Clinical journal of pain.

[57]  E. Yelin,et al.  Special article the economic cost and social and psychological impact of musculoskeletal conditions , 1995 .

[58]  V. Mutt,et al.  Polypeptide with Broad Biological Activity: Isolation from Small Intestine , 1970, Science.

[59]  D. Felson,et al.  Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. , 1999, The American journal of medicine.

[60]  I. Lygren,et al.  Gastrointestinal peptides in serum and synovial fluid from patients with inflammatory joint disease. , 1986, Annals of the rheumatic diseases.

[61]  L. Kazis,et al.  The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis , 2001, Annals of Internal Medicine.

[62]  D. Walsh,et al.  Neurovascular invasion at the osteochondral junction and in osteophytes in osteoarthritis , 2007, Annals of the rheumatic diseases.

[63]  R. McCarney,et al.  Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care , 2001, Annals of the rheumatic diseases.

[64]  W. Ferrell,et al.  Prolonged alteration of vasoconstrictor and vasodilator responses in rat knee joints by adjuvant monoarthritis , 1995, Experimental physiology.

[65]  A Guermazi,et al.  The relationship between specific tissue lesions and pain severity in persons with knee osteoarthritis. , 2006, Osteoarthritis and cartilage.

[66]  G. Affleck,et al.  The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing , 2000, Pain.

[67]  F. Wilder,et al.  Osteoarthritis pain and weather. , 2003, Rheumatology.

[68]  M. Englund,et al.  Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. , 2004, Arthritis and rheumatism.

[69]  Ugo Della Croce,et al.  Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis. , 2005, Archives of physical medicine and rehabilitation.

[70]  T. Spector,et al.  Association of pain with radiological changes in different compartments and views of the knee joint. , 1996, Osteoarthritis and cartilage.

[71]  J. McDougall,et al.  Electrophysiological evidence that the vasoactive intestinal peptide receptor antagonist VIP6-28 reduces nociception in an animal model of osteoarthritis. , 2006, Osteoarthritis and cartilage.

[72]  Saara Totterman,et al.  The Clinical Importance of Meniscal Tears Demonstrated by Magnetic Resonance Imaging in Osteoarthritis of the Knee* , 2003, The Journal of bone and joint surgery. American volume.

[73]  W W Hauck,et al.  The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. , 1989, American journal of epidemiology.

[74]  L. Kazis,et al.  Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. , 2001, The Journal of rheumatology.

[75]  David A. Seminowicz,et al.  Cortical responses to pain in healthy individuals depends on pain catastrophizing , 2006, Pain.

[76]  J. McDougall,et al.  Morphological and immunohistochemical examination of nerves in normal and injured collateral ligaments of rat, rabbit, and human knee joints , 1997, The Anatomical record.

[77]  L. Draganich,et al.  Osteoarthritis of the Knees Increases the Propensity to Trip on an Obstacle , 2005, Clinical orthopaedics and related research.

[78]  Jolanda Cibere,et al.  Do we need radiographs to diagnose osteoarthritis? , 2006, Best practice & research. Clinical rheumatology.

[79]  L. Kazis,et al.  The Association of Bone Marrow Lesions with Pain in Knee Osteoarthritis , 2001, Annals of Internal Medicine.

[80]  J. Fries,et al.  The risk of osteoarthritis with running and aging: a 5-year longitudinal study. , 1993, The Journal of rheumatology.

[81]  H. Schaible,et al.  Pathophysiology of pain , 2004, Langenbeck's Archives of Surgery.

[82]  H. Schaible,et al.  Afferent and spinal mechanisms of joint pain , 1993, Pain.

[83]  P. Allard,et al.  Foot Position Awareness in Younger and Older Men: The Influence of Footwear Sole Properties , 1997, Journal of the American Geriatrics Society.

[84]  J. McDougall,et al.  Attenuation of knee joint inflammation by peripherally administered endomorphin-1 , 2007, Journal of Molecular Neuroscience.

[85]  F. Keefe,et al.  Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis. , 2002, Journal of consulting and clinical psychology.

[86]  J. Kelsey,et al.  Epidemiology of musculoskeletal impairments and associated disability. , 1984, American journal of public health.

[87]  T. McAlindon,et al.  Effectiveness of glucosamine for symptoms of knee osteoarthritis: results from an internet-based randomized double-blind controlled trial. , 2004, The American journal of medicine.

[88]  R. Altman Classification of disease: osteoarthritis. , 1991, Seminars in arthritis and rheumatism.

[89]  C. Woolf,et al.  Neuronal plasticity: increasing the gain in pain. , 2000, Science.

[90]  C. Hanson,et al.  Is Running Associated with Osteoarthritis? An Eight‐Year Follow‐up Study , 1995, Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases.

[91]  C. Helmick,et al.  Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. , 1998, Arthritis and rheumatism.

[92]  S. Mazzuca,et al.  Quadriceps Weakness and Osteoarthritis of the Knee , 1997, Annals of Internal Medicine.

[93]  W. Maixner,et al.  Self-efficacy for arthritis pain: relationship to perception of thermal laboratory pain stimuli. , 1997, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[94]  J. McDougall,et al.  Vasoactive intestinal peptide (VIP) is a modulator of joint pain in a rat model of osteoarthritis , 2006, Pain.

[95]  P. Dieppe,et al.  Pathogenesis and management of pain in osteoarthritis , 2005, The Lancet.

[96]  D. Felson,et al.  Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. , 2000, The Journal of rheumatology.

[97]  P. Mantyh,et al.  Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur , 2002, Neuroscience.

[98]  J. McDougall Arthritis and Pain. Neurogenic origin of joint pain , 2006, Arthritis research & therapy.

[99]  P. Simkin Bone pain and pressure in osteoarthritic joints. , 2004, Novartis Foundation symposium.

[100]  K. Lorig,et al.  Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. , 1993, Arthritis and rheumatism.

[101]  D. Felson Do occupation-related physical factors contribute to arthritis? , 1994, Bailliere's clinical rheumatology.