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Osteoarthritis (OA) is the most common cause of arthritis, and is associated with significant pain and disability. Epidemiological study showed a large number of the eldery in Japan suffered OA, especially OA of the knee. Rapid diagnosis and conservative treatments those includes patient education, weight loss, exercise, physical and occupational therapy are effective at early stage. Pharmacologic treatment are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) including cyclooxygenase-2 (COX-2) selective agents. Surgery of the joint arthroplasty significantly reduces knee and hip pain, and restores the functions of the patient at the end stage.

Although a large number of studies have been made to identify genetic loci associated with osteoarthritis (OA), there are only a few that have been reported to be associated with OA in many regions and countries. One of the reasons for the lack of success may be small effect sizes. A sufficiently large sample size is required for the genetic epidemiology on OA to elucidate genetic influence regarding the occurrence and progression.

Now, It is becoming known that the mechanisms of cartilage matrix destruction such as roles of degradative enzymes including matrix metalloproteinase (MMP), aggrecanase, and cathepsin K and cytokines. For prevention of progression of cartilage destruction, it is important to develop the reliable biomarkers to detect the early stage of cartilage destruction. We reviewed the specific destructive products of type II collagen, major component of cartilage matrix, generated by collagenases and cathepsin K as well as those of aggrecan generated by MMPs and aggrecanase. The biomarker could be useful tool not only to understand the progression of joint destruction in osteoarthritis and rheumatoid arthritis but also to develop new treatment.

Japan became a superaging society. We have been putting a new focus on locomotive syndrome and frailty. The prevention and treatment of locomotive syndromes, such as osteoarthritis, degenerative spondylosis, lumbar canal stenosis, osteoporosis, upper extremity diseases, rheumatoid arthritis, and many other disorders of the locomotive organs are important. Because, the locomotive syndrome results in deterioration of the exercise function and loss of mental and physical health. The aim of locomotive syndrome exercises are: to reduce pain, to restore and improve joint function. We need to take a comprehensive approach to locomotive syndrome, including lifestyle modification, muscle exercise, stretching and therapeutic exercise.

The most recommendable MRI sequence for the morphologic assessment of the cartilage damage due to osteoarthritis (OA) is gradient echo fat suppression T1 weighted image (SPGR: Spoiled gradient recalled acquisition in the steady state, FLASH: Fast low-angle shot). For the detection of the cartilage degeneration before the morphological change, T2 mapping, dGEMRIC (delayed Gd-DTPA2-Enhanced MRI of Cartilage), and T1ρ mapping are suggested. Subchondral bone structural changes such as bone sclerosis and cyst are deeply related to the etiology of OA, and quantitative evaluation for them using MDCT (Multi-Detector row CT) and 3TMRI are suggested.

In the process of cartilage degeneration seen in osteoarthritis, loss of proteoglycan from articular cartilage has been widely accepted as a critical early event, followed by collagen degradation designated as a point of no return. Recent advance in the development of targeted molecular probes and new imaging modalities enabled the detection of qualitative and functional change of articular cartilage. In this paper, we describe the recent progress of bio-molecular imaging of articular cartilage including our fluorescent-labeled glycosaminoglycan-binding octaarginine.

It is socially required to establish the correlation of some specific biomarkers and the clinical stage of osteoarthritis (OA). This study is to evaluate the usefulness of serum or urine biomarkers in OA in the large population cohort study of Japan. There are many reports to evaluate the usefulness of biological markers in OA, and the similar clinical results are supported in this study. The further follow-up study would be wished to be done.

Osteoarthritis (OA) is a degenerative joint disease that causes physical disability in many elderly people. Multiple risk factors, including age, gender, genetics, overuse, trauma and obesity, are involved in the onset and progression of OA. Various biological and molecular events that occur in OA joint have been intensively studied and there is an increasing appreciation of the contribution of joint tissues in addition to cartilage. Recent investigations are further deepening the understanding on the importance of matrix-degrading enzymes, chondrocyte hypertrophy and apoptosis, subchondral bone metabolism, cytokines and inflammation. All these serve as therapeutic targets. However, there are currently no clinical interventions proven to restore cartilage and inhibit disease processes. With research efforts for the identification of better therapeutic target together with reliable imaging and biomarkers for evaluation, we expect to have guide for potential disease-modifying agents.

Osteoarthritis (OA) is characterized by increased cartilage degradation and wearing. The principal disease hallmarks for assessment of OA are radiographic aspects. However, laboratory markers of joint fluid, serum or urine have received growing attention in recent years. Biomarkers should be useful for improvement of diagnosis, assessment of disease progression and evaluation of therapeutic effects in OA. Here we described the outline of biomarkers in cartilage including utility and weakness.

Biological markers for osteoarthritis (OA) are indicators of articular tissue metabolism, measuring the levels of molecules derived from joint structures into synovial fluids, serum and urine. Radiological findings are the basis of diagnosis of OA, but have a weakpoint visualizing the figures that have already occurred. For assessing disease activity or monitoring disease progression, estimation of articular metabolism using biological markers is very important. Synovial fluid reflects specifically the status of the punctured joint, however invasive. Less-invasive newly developed serum and urine markers appear to be also useful for the evaluation of OA.

Now, the biomarker for bone metabolism have important role on treatment of osteoporosis. It is important to develop the reliable biomarker to detect the early stage of osteoarthritis. The biomarker could be useful tool not only to study what exercise is good for the treatment and prevention of progression of osteoarthritis but also to develop new drug therapy. We focused on role of cleavage of type II collagen by collagenase in osteoarthritis with immunoassay for the specific cleavage site.

The aim of this study was to identify genes responsible for the formation and maintenance of cartilage tissue. For this purpose, gene expression patterns were compared between differentiating and dedifferentiating chondrocytes by cDNA macroarray analysis. A total of 1,186 genes were examined, and at least 7 genes were identified as candidate genes having critical roles in cartilages. Three of them encode well-known cartilage matrix molecules: aggrecan, decorin and type IX collagen, and others were preproenkephalin A, Early Growth Response-1, Early Growth Response-3, and basigin. All these genes were expressed at high level in mature cartilage, but their expressions were suppressed in response to dedifferentiation of chondrocytes. Meanwhile, transcription factor ALY, variant in the kinase (vik), and syndecan 2 genes were newly activated during the process of chondrocyte dedifferentiation. A similar process is somewhat observed in osteoarthritis. Therefore, activation of these genes might be closely related to the progression of osteoarthritis and would be a useful marker for it.

We report a 61-year-old man with diabetic polyneuropathy and bilateral ulnar nerve palsy due to osteoarthrosis in the elbow. He was diagnosed as having non-insulin dependent diabetes mellitus (DM) at 40 years of age. At 56 years of age, he developed muscle atrophy and weakness predominantly in the distal parts of his upper limbs. A neurological examination showed him to have severe atrophy and weakness in the muscles innervated by the ulnar nerve bilaterally. He also had paresthesia on the distal parts of all four limbs. Superficial and deep sensory deficits were observed in the lower limbs. A motor nerve conduction study showed a marked reduction in the motor conduction velocity as well as in the amplitude of the action potentials of both ulnar nerves. Roentgenograms of the elbow joints and grooves for the ulnar nerve revealed marked osteophyte formation bilaterally. The bilateral ulnar nerve palsy was thus considered to be due to the entrapment of the nerve by the osteophyte. Since several studies have suggested the existence of a relationship between DM and osteoarthropathy, it is important to check for the possible presence of osteoarthrosis in cases of diabetic neuropathy complicated with entrapment neuropathy.

Osteoarthritis is the most common cause of knee pain in the aged. This disease is characterized by degenerative changes in the articular cartilage and subsequent new bone formation at the articular margins. The primary defect in hyaline cartilage is an alteration in the ratio of total glycosaminoglycans to that of the collagen fiber content in the matrix. The disease frequently is primary but various predisposing conditions are recognized. In early phase of this disease, the patient complains of pain, which appears with exercise but can be "walked off". The joint is often felt to creak and grate, and swells from time to time, especially after any unusual activity involving a flexed position. As the disease progresses, the patient finds increasing difficulty in the activities of daily life. It should be emphasized that, in the early phase, almost of all patients can be managed by conservative means such as weight loss, isometric quadriceps exercises, use of a walking stick and antiinflammatory analgesic drugs. The predominant indication for surgical treatment is persistent pain and serious disturbance of the activities of daily life against conservative treatment. High tibial osteotomy has proved to be useful in the medial osteoarthritic knees. However, the long-term follow-up studies conducted by the author have shown that effects of this procedure gradually deteriorate after 10 years. Clinical results of total prosthetic replacement of the knee joint have been well improved in this decade. Ten-year survivorship has recently been reported to be 95% or more. However, the most common problem is loosening of the component. Wear particles derived from the tibial plate made from ultra high molecular weight polyethylene have been noted as the primary cause of the loosening.

Sialic acids, derivatives of neuraminic acid, are present as structural components of mucoprotein mainly in the alpha 1 and alpha 2-globulin regions, and they are known to change in diseases associated with acute inflammation or tissue necrosis. The present study was performed to clarify the significance of measurements of sialic acids in the serum and synovial fluid of patients with diseases in the field of orthopaedic surgery. 1. Serum sialic acids were markedly high in cases of acute pyogenic diseases and showed moderately high values in stage 2 or 3 of rheumatoid arthritis (RA). There was a close correlation with ESR in RA cases and with CRP in cases of acute pyogenic diseases. Differences in the correlation with ESR and CRP were seen in proportion to the severity of the inflammation. 2. Synovial fluid sialic acids were high in cases of RA, and within the normal range in cases of osteoarthritis. The values changed within this range in accordance with treatment. In RA cases, there was a significant correlation with monocytes in the synovial fluid. 3. Serum sialic acids appeared to be sufficiently useful as a parameter of inflammation independent of ESR and CRP, and synovial fluid sialic acids were also considered to be useful for differentiation between RA and OA.

Sounds from the joints are still in the mysterious zone. It seems to be important to study the sound which occurs on motions. Here, a new analysing method and its clinical application are presented and discussed. The joint which is studied, is moved in some ranges for four seconds in the unechoic chamber, and a special microphone is kept to touch on the pan-articular skin manually throughout the motion. These collected sounds are analyzed with a narrow band spectrum analyzer (Br uel & Kjaer Co., 2031 Type) and a computer. In the unechoic chamber, it may diminished the background noises. The narrow band spectrum analyzer made it possible not to use the magnetic tape which usually induced much noise. Furthermore, as the computer system is utilized, it become easy to compile the data of each frequency analysis and to obtain over all value, with which the sound volume can be compared with each other. The over all value means an integrated volume of each joint sound. In this paper, joint sound were obtained from normal and pathological human joints. In the normal cases, the frequency analysis data showed almost flat spectrum curves, and the total over all values (0.5 kHz to 5 kHz) were usually less than 80 dB. On the other hand, in the pathological joints which had bony changes affected by rheumatoid arthritis, degenerative osteoarthritis, fracture, and others, the frequency analysis showed elevated curves in range from 0.5 kHz to 4.0 kHz, and the total over all value increased in each pathological joint. In 85 cases of osteoarthrosis of the knee joints, the total over all values were a wide dispersion from 76 to 104 dB. And these values and radiological grading (by Swanson) correlated to each other. The over all values at each 0.5 kHz interval, especially from 0.5 to 1.5 kHz, were maximum ones in each radiological gradings. It is concluded that these results in osteoarthrosis cases, are related to with radiological gradings.