Osteoarthritis as a disease of mechanics
Open accessAbstract
Mechanics means relating to or caused by movement or physical forces. In this paper, I shall contend that osteoarthritis (OA) is almost always caused by increased physical forces causing damage to a joint. While examples of joint injury causing OA are numerous, I shall contend that most or almost all OA is caused in part by mechanically induced injury to joint tissues. Further, once joint pathology has developed, as is the case for almost all clinical OA, pathomechanics overwhelms all other factors in causing disease progression. Treatments which correct the pathomechanics have long lasting favorable effects on pain and joint function compared with treatments that suppress inflammation which have only temporary effects. I shall lastly contend that the mechanically induced joint injury leads to variable inflammatory responses but that the role of this inflammation in worsening structural damage in an already osteoarthritic joint has not yet been proven.
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The present diagnostic paradigm is not sensitive enough to identify early molecular and cellular changes that precede macroscopic tissue degradation, delaying diagnosis and treatment during the most therapeutically sensitive period.
“Moreover, the present diagnostic paradigm is not sensitive enough to identify early molecular and cellular changes that precede macroscopic tissue degradation, therefore delaying diagnosis and treatment during the most therapeutically sensitive period of illness [6,7].”
From Biomarker-Guided Imaging and AI-Augmented Diagnosis of Degenerative Joint Disease (2025) · cites this paper as [7]
The Introduction (page unavailable) says that patients typically present for treatment only after considerable joint pathology exists, supporting the limited point that treatment often begins late. It does not say that current diagnostics miss early molecular or cellular changes, that diagnostic insensitivity causes the delay, or that the missed period is the most therapeutically sensitive. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEarly diagnosis of degenerative joint disease poses a significant clinical challenge because of its gradual onset and symptom overlap with other musculoskeletal disorders.
“Degenerative joint disease remains a leading cause of global disability, with early diagnosis posing a significant clinical challenge due to its gradual onset and symptom overlap with other musculoskeletal disorders.”
From Biomarker-Guided Imaging and AI-Augmented Diagnosis of Degenerative Joint Disease (2025) · cites this paper as [7]
The Introduction (page unavailable) says patients with osteoarthritis typically develop symptoms and present for treatment only after considerable joint pathology exists, which bears on the difficulty of recognizing disease early. It does not say that gradual onset or symptom overlap with other musculoskeletal disorders makes early diagnosis a clinical challenge. (LLM, conf=0.76)
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- Authors
- Felson, D. T.
- Affiliations
- Boston University (US)
- Corresponding author
- Felson, D.T.
- ORCID
- Felson, D.T.
- Venue
- Osteoarthritis and Cartilage
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 21
- Issue
- 1
- Pages
- 10-15
- ISSN
- 1063-4584 (ISSN-L)
- PMC
- PMC3538894
- OpenAlex
- W2029351075
- Cited by
- 676
- References
- 45
- Citations by year
- 2026: 58 · 2025: 74 · 2024: 54 · 2023: 56 · 2022: 57 · 2021: 65 · 2020: 59 · 2019: 45 · 2018: 44 · 2017: 35 · 2016: 45 · 2015: 46 · 2014: 29 · 2013: 9
- FWCI
- 4.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Osteoarthritis and Cartilage (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR051568, AR 47785, P60AR047785)
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- osteoarthritis, pathomechanics, mechanical loading, joint injuries, disease progression, inflammation, pain, joint function, structural damage
- MeSH terms
- Anterior Cruciate Ligament Injuries, Tibial Meniscus Injuries, Animals, Humans, Knee Injuries, Knee Joint, Menisci, Tibial, Osteoarthritis, Hip, Osteoarthritis, Knee
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