Gardner D L
Department of Pathology, University of Edinburgh, Scotland, UK.
J Anat. 1994 Jun;184 ( Pt 3)(Pt 3):465-76.
This short review outlines aspects of joints relevant to current problems in articular, connective tissue disease and describes the pathology of rheumatoid arthritis and osteoarthrosis. The synovial joints display greatly varying degrees of anatomical specialisation. There is also heterogeneity of microscopic structure, to illustrate which the synovial components of the sacroiliac joints are considered. The chondron is regarded as a functional unit of hyaline articular cartilage but the responses of this tissue in disease are strongly influenced by its avascularity and by the need for chondrocytes to communicate with each other and with their local and systemic environments. Hyaline cartilage is capable of molecular replacement or substitution but not of repair by regeneration; it can, however, be replaced by fibrocartilage. The bearing surfaces of hyaline articular cartilage are never planar or smooth. Rheumatoid arthritis is a paradigm of connective tissue disease. It is not only a systemic disorder which may abbreviate life but, characteristically, is an aseptic form of symmetric polyarthritis. The inheritance of HLA-DR beta 1 and of female sex predispose to rheumatoid arthritis but the cause is unknown; it may be viral. Central to the disease is destruction of articular cartilage by sustained inflammation in which activated macrophages and TH cells, possibly of restricted clonality, combine to release cytokines, proteinases and the mediators of inflammation. Osteoarthrosis is a synovial joint syndrome, not a single disease. It is characterised by a loss of and change in the composition of cartilage proteoglycans leading to failure of normal responses to stress. The results include cartilage fibrillation and loss, bone exposure and a clinical syndrome of pain and disability. Rare forms of heritable chondrodysplasia lead to premature osteoarthrosis but, in most instances, the cause of osteoarthrosis appears to be either excess, inappropriate or insufficient mechanical demand, or traumatic, infective, inflammatory, endocrine or metabolic disease. There remain idiopathic ('primary') cases in which no cause is demonstrable.
这篇简短的综述概述了与关节相关的、与当前关节及结缔组织疾病问题有关的方面，并描述了类风湿性关节炎和骨关节炎的病理学。滑膜关节在解剖学特化程度上差异极大。微观结构也存在异质性，为说明这一点，本文以骶髂关节的滑膜成分进行阐述。软骨单位被视为透明关节软骨的功能单位，但该组织在疾病中的反应受到其无血管性以及软骨细胞相互之间及其与局部和全身环境进行沟通需求的强烈影响。透明软骨能够进行分子替代或置换，但不能通过再生进行修复；然而，它可以被纤维软骨替代。透明关节软骨的承重表面从不平整或光滑。类风湿性关节炎是结缔组织疾病的典范。它不仅是一种可能缩短寿命的全身性疾病，而且典型地是一种无菌性的对称性多关节炎形式。HLA - DRβ1基因的遗传以及女性性别易患类风湿性关节炎，但病因不明；可能是病毒感染。该疾病的核心是持续炎症导致关节软骨破坏，其中活化的巨噬细胞和TH细胞（可能具有有限的克隆性）共同释放细胞因子、蛋白酶和炎症介质。骨关节炎是一种滑膜关节综合征，而非单一疾病。其特征是软骨蛋白聚糖的组成丧失和改变，导致对压力的正常反应失效。结果包括软骨原纤维形成和丧失、骨质暴露以及疼痛和残疾的临床综合征。罕见的遗传性软骨发育异常形式会导致过早发生骨关节炎，但在大多数情况下，骨关节炎的病因似乎是过度、不适当或不足的机械需求，或创伤、感染、炎症、内分泌或代谢疾病。仍有一些特发性（“原发性”）病例，其中找不到病因。
