Fine Noah, Lively Starlee, Séguin Cheryle Ann, Perruccio Anthony V, Kapoor Mohit, Rampersaud Raja
Osteoarthritis Research Program, Division of Orthopaedics, Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada.
Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Nat Rev Rheumatol. 2023 Mar;19(3):136-152. doi: 10.1038/s41584-022-00888-z. Epub 2023 Jan 26.
Intervertebral disc degeneration (IDD) and osteoarthritis (OA) affecting the facet joint of the spine are biomechanically interdependent, typically occur in tandem, and have considerable epidemiological and pathophysiological overlap. Historically, the distinctions between these degenerative diseases have been emphasized. Therefore, research in the two fields often occurs independently without adequate consideration of the co-dependence of the two sites, which reside within the same functional spinal unit. Emerging evidence from animal models of spine degeneration highlight the interdependence of IDD and facet joint OA, warranting a review of the parallels between these two degenerative phenomena for the benefit of both clinicians and research scientists. This Review discusses the pathophysiological aspects of IDD and OA, with an emphasis on tissue, cellular and molecular pathways of degeneration. Although the intervertebral disc and synovial facet joint are biologically distinct structures that are amenable to reductive scientific consideration, substantial overlap exists between the molecular pathways and processes of degeneration (including cartilage destruction, extracellular matrix degeneration and osteophyte formation) that occur at these sites. Thus, researchers, clinicians, advocates and policy-makers should consider viewing the burden and management of spinal degeneration holistically as part of the OA disease continuum.
影响脊柱小关节的椎间盘退变(IDD)和骨关节炎(OA)在生物力学上相互依存,通常同时发生,且在流行病学和病理生理学方面有相当大的重叠。从历史上看,人们一直强调这些退行性疾病之间的区别。因此,这两个领域的研究往往独立进行,没有充分考虑位于同一功能脊柱单元内的这两个部位的相互依存关系。来自脊柱退变动物模型的新证据突显了IDD和小关节OA的相互依存性,有必要对这两种退行性现象之间的相似之处进行综述,以造福临床医生和科研人员。本综述讨论了IDD和OA的病理生理学方面,重点关注退变的组织、细胞和分子途径。虽然椎间盘和滑膜小关节在生物学上是不同的结构,适合进行简化的科学研究,但在这些部位发生的退变的分子途径和过程(包括软骨破坏、细胞外基质退变和骨赘形成)之间存在大量重叠。因此,研究人员、临床医生、倡导者和政策制定者应考虑将脊柱退变的负担和管理作为OA疾病连续体的一部分进行整体看待。
Nat Rev Rheumatol. 2023-3
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