What disease is caused by the breakdown of cartilage?

Osteoarthritis is a degenerative joint disease that can affect the many tissues of the joint. It is by far the most common form of arthritis, affecting more than 32.5 million adults in the United States, according to the Centers for Disease Control and Prevention.

Historically, osteoarthritis (OA) was known as a “wear and tear” condition, generally associated with aging. But we know now that it is a disease of the entire joint, including bone, cartilage, ligaments, fat and the tissues lining the joint (the synovium). Osteoarthritis can degrade cartilage, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility.

OA can affect any joint, but typically affects hands, knees, hips, lower back and neck. Its signs and symptoms typically show up more often in individuals over age 50, but OA can affect much younger people, too, especially those who have had a prior joint injury, such as a torn ACL or meniscus. It typically develops slowly over time, but after such an injury, it can develop much more rapidly, within just a few years. OA is not an inevitable aging disease; some people never develop it.

There is no cure for OA, but there are ways to manage OA to minimize pain, continue physical activities, maintain a good quality of life and remain mobile.

Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.

With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.

What are the signs and symptoms of OA?

• Pain or aching
• Stiffness
• Decreased range of motion (or flexibility)
• Swelling

How many people have OA?

OA affects over 32.5 million US adults.

What causes OA?

OA is caused by damage or breakdown of joint cartilage between bones.

What are the risk factors for OA?

• Joint injury or overuse—Injury or overuse, such as knee bending and repetitive stress on a joint, can damage a joint and increase the risk of OA in that joint.
• Age—The risk of developing OA increases with age.
• Gender—Women are more likely to develop OA than men, especially after age 50.
• Obesity—Extra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees. This stress increases the risk of OA in that joint. Obesity may also have metabolic effects that increase the risk of OA.
• Genetics—People who have family members with OA are more likely to develop OA. People who have hand OA are more likely to develop knee OA.
• Race— Some Asian populations have lower risk for OA.

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How is OA diagnosed?

A doctor diagnoses OA through a review of symptoms, physical examination, X-rays, and lab tests.
A rheumatologist, a doctor who specializes in arthritis and other related conditions, can help if there are any questions about the diagnosis.

There is no cure for OA, so doctors usually treat OA symptoms with a combination of therapies, which may include the following:

• Increasing physical activity
• Physical therapy with muscle strengthening exercises
• Weight loss
• Medications, including over-the-counter pain relievers and prescription drugs
• Supportive devices such as crutches or canes
• Surgery (if other treatment options have not been effective)

In addition to these treatments, people can gain confidence in managing their OA with self-management strategies. These strategies help reduce pain and disability so people with osteoarthritis can pursue the activities that are important to them. These five simple and effective arthritis management strategies can help.

CDC’s Arthritis Program recommends five self-management strategies for managing arthritis and its symptoms.

• Learn self-management skills. Join a self-management education class, which helps people with arthritis and other chronic conditions—including OA—understand how arthritis affects their lives and increase their confidence in controlling their symptoms and living well. Learn more about the CDC-recommended self-management education programs.
• Get physically active. Experts recommend that adults engage in 150 minutes per week of at least moderate physical activity. Every minute of activity counts, and any activity is better than none. Moderate, low impact activities recommended include walking, swimming, or biking. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease, stroke, and diabetes. Learn more about physical activity for arthritis.
  • Go to effective physical activity programs. For people who worry that physical activity may make OA worse or are unsure how to exercise safely, participation in physical activity programs can help reduce pain and disability related to arthritis and improve mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help people with OA feel better. Learn more about CDC-recommended physical activity programs.

• Talk to your doctor. You can play an active role in controlling your arthritis by attending regular appointments with your health care provider and following your recommended treatment plan. This is especially important if you also have other chronic conditions, like diabetes or heart disease.
• Lose weight. For people who are overweight or obese, losing weight reduces pressure on joints, particularly weight bearing joints like the hips and knees. Reaching or maintaining a healthy weight can relieve pain, improve function, and slow the progression of OA.
• Protect your joints. Joint injuries can cause or worsen arthritis. Choose activities that are easy on the joints like walking, bicycling, and swimming. These low-impact activities have a low risk of injury and do not twist or put too much stress on the joints. Learn more about how to exercise safely with arthritis.

Learn more about osteoarthritis

Learn more about Arthritis

NORD gratefully acknowledges Naveed Younis, MD, Consultant Physician, Department of Medicine, University Hospital of South Manchester, Wythenshawe Hospital, United Kingdom, for assistance in the preparation of this report.

• chronic atrophic polychondritis
• generalized or systemic chondromalocia
• Meyenburg-Altherr-Uehlinger syndrome
• relapsing perichondritis
• von Meyenburg disease

Relapsing polychondritis is a rare degenerative disease characterized by recurrent inflammation of the cartilage in the body. Deterioration of the cartilage may affect any site of the body where cartilage is present. Ears, larynx and trachea may become “floppy,” and the bridge of the nose can collapse into a “saddlenose” shape. The aortic heart valve may also be affected.

Symptoms of relapsing polychondritis usually begin with the sudden onset of pain, tenderness and swelling of the cartilage of one or both ears. This inflammation may spread to the fleshy portion of the outer ear causing it to narrow. Attacks may last several days to weeks before subsiding. Middle ear inflammation can cause obstruction of the eustachian tube. Recurrent attacks may lead to hearing loss.

Nasal chondritis may be marked by cartilage collapse at the bridge of the nose resulting in a saddle nose deformity, nasal stuffiness or fullness and crusting.

Inflammation of both large and small joints can occur. Classic symptoms of pain and swelling are similar to those of arthritis.

Involvement of the cartilage of the larynx and bronchial tubes may cause breathing and speech difficulties.

Heart valve abnormalities may occur.

Relapsing polychondritis may also cause kidney inflammation and dysfunction.

The exact cause of relapsing polychondritis is not known. It is thought to be an autoimmune disease. Autoimmune disorders are caused when the body’s natural defenses against “foreign” or invading organisms (e.g., antibodies) begin to attack healthy tissue for unknown reasons. Some cases may be linked to abnormal reactions by blood cells (serum antibodies), to a thyroid protein (thyroglobulin), organ wall (parietal) cells, adrenal cells, or thyroid. Symptoms of relapsing polychondritis may arise when autoantibodies attack human cartilage.

Some researchers believe that relapsing relapsing polychondritis may be caused by an immunologic sensitivity to type II collagen, a normal substance found in skin and connective tissue.

Relapsing polychondritis affects males and females in equal numbers. Symptoms usually begin between forty and sixty years of age.

Treatment
Treatment of relapsing polychondritis usually involves the administration of corticosteroid drugs (e.g., prednisone), aspirin and non-steroidal anti-inflammatory compounds such as dapsone and/or colchicine. In extreme cases, drugs that suppress the immune system such as cyclophosphamide, 6-mercaptopurine and azathioprine may be recommended. In the most severe cases replacement of heart valves or the insertion of a breathing tube (tracheotomy) for collapsed airways may be necessary.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.

For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222 TTY: (866) 411-1010

Email: [email protected]

Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/for-patients-and-families/information-resources/news-patient-recruitment/

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/

Some cases of relapsing polychondritis may go into remission after use of the immune suppressing drug cyclosporine-A. However, more research is necessary to determine complete safety and effectiveness of this treatment.

In the medical literature, there is a report of a child with relapsing polychondritis whose symptoms improved after treatment with type II collagen (CII). More research is necessary to determine the effectiveness and long-term safety of this potential treatment for relapsing polychondritis.

TEXTBOOKS
Stein, JH, ed. Internal Medicine. 4th ed. St. Louis, MO:Mosby-Year Book, Inc.; 1994:2406, 2465.

Kelley WN, et al., eds. Textbook of Rheumatology. 4th ed. Philadelphia, PA: W.B. Saunders Company; 1993:1400-09.

JOURNAL ARTICLES
Navarro MJ, et al. Amelioration of relapsing polychondritis in a child treated with oral collagen. Am J Med Sci. 2002;324:101-3.

Letko E, et al. Relapsing polychondritis: a clinical review. Semin Arthritis Rheum. 2002;31:384-95.

Balsa-Criado A, et al. Cardiac involvement in relapsing polychondritis. Int J Cardiol. 1987;14:381-83.

Michet CJ, et al. Relapsing polychondritis. Survival and predictive role of early disease manifestations. Ann Intern Med. 1986;104:74-78.

Krell WS, et al. Pulmonary function in relapsing polychondritis. Am Rev Respir Dis. 1986;133:1120-23.

INTERNET
Compton N. Polychondritis. Medscape. Updated: Sep 25, 2017. http://emedicine.medscape.com/article/331475-overview Accessed Sept. 13, 2018.

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