In this issue, we will discuss osteoarthritis and venous insufficiency
Osteoarthritis (OA) used to be defined as a disease characterized mainly by degeneration of cartilage, but in recent years it has been considered as a joint defect involving the entire joint, including cartilage, synovium, subchondral bone and ligamentous tissue.
Regarding the pathophysiology of OA, results regarding circulatory disturbances and their effect on the subchondral bone microenvironment are limited.
Vessels are specifically located at sites of bone resorption, and alterations in bone perfusion have been shown to cause hypoxia in the subchondral bone, leading to intraosseous hypertension and increased bone resorption.
Increased subchondral bone resorption has been associated with subchondral osteosclerosis and cartilage thinning.
Osteoarthritis and chronic venous disease share common risk factors such as obesity and prolonged standing, and chronic venous disease, especially venous insufficiency (VI), is associated with venous hypertension.Several studies have evaluated the contribution of circulatory disturbances in the pathophysiology of OA, and the study presented here investigates this relationship.
The studies
Between February 2012 and May 2013, 103 participants were included in the study.
The study group included 59 patients diagnosed with knee OA, and the control group included 44 healthy volunteers with no knee joint complaints.
Demographic and clinical characteristics of all participants were recorded, and the venous system of the lower extremities was assessed by Doppler ultrasonography.
All knees were assessed using conventional radiography based on the Kellgren-Lawrence (K&L) grading system and ultrasonography.
Pain severity was assessed using the Likert pain scale and function was assessed using the Western Ontario, McMaster University Osteoarthritis Index (WOMAC).
For venous insufficiency.
40.6% of the OA group
15.9% of the control group
Venous insufficiency was detected in (p = 0.007)
There was no statistically significant difference between cartilage thickness and K&L grading for the presence of VI.
However, the percentage of medial tibial sclerosis on radiographs was higher in patients with VI in the OA group (60%), resulting in a higher WOMAC pain score in patients with deep VI, although the total WOMAC score was similar in both groups.
Güneş S, Şehim K, Cüneyt K, Gökmen D, Küçükdeveci AA. Is there a relationship between venous insufficiency and knee osteoarthritis? Turk J Phys Med Rehabil. 2020;66(1):40-46. Published 2020 Mar 3. doi:10.5606/tftrd.2020.5110
Conclusion and Summary
The results of increased radiographic medial tibial sclerosis and higher WOMAC pain scores in patients with venous involvement in OA may lead to the hypothesis that venous system pathology affects the intraosseous microenvironment of the bone, resulting in pain and early subchondral bone involvement, which in turn manifests as "subchondral sclerosis".
Although I thought I had studied OA, I learned something new about the pathophysiology of subchondral sclerosis due to these complications.
