PATHOLOGY

The earliest lesions of degenerative joint disease are microscopic alterations of

articulr cartilage. These include diminution of metachromatic material, decreased
numbers of chondrocytes, fatty degeneration, alteration of collagen fibrils, and surface
irregularities.
Later morphologic changes include localized softening of the cartilage with surface
flaking and fibrillations. Abrasion of fibrillated cartilage results in progressive loss of
cartilaginous surfacing and exposure of subchondral bone.
Subsequent to ulcerations of cartilage, new bone formation occurs at the margin of
articular cartilage. These marginal osteophytes are represented in roentgenograms as
the characteristics spurs. Other asseous changes include cysts of varying size
beneath the joint surface and remodeling of subhondral bone.
Changes in synovial membranes, including fibrosis, hypertrophy, and occasionally
synovitis appear to be secondary to events affecting articular cartilage.
FIGURE
DIFFERENTIAL DIAGNOSIS
In their typical expressions, degenerative joint disease and rheumatoid arthritis
are easily distinguished. The latter is usually associated with evidence of systemic
disease, prominent signs of joint inflammation, and the characteristics symmetrical
pattern of disease affecting the hands and wrists.
When a patient presents with signs of mild inflammation in one or two weight-bearing
joints of the lower extremities, the differentiation between these two syndromes is
more difficult.
In the setting a normal erythrocyte sedimentation rate, negative rheumatoid factor test
result, and minimal abnormalities is synovial fluid support the diagnosis of
degenerative joint disease.
A common diagnostic error is the interpretation of degenerative changes in proximal
interphalangeal joints of the hands as evidence of rheumatoid arthritis (Fig.2B). The
deformities that characterize Heberdens and Bouchards nodes may be marked, but
this pattern of degenerative joint disease is usually not associated with prominent
signs of inflammation, and the metacarpophalangeal joints and wrist joints are rarely
or never affected.
Important aspects of differential diagnosis involve the recognition of syndromes in
which secondary development of degenerative joint disease may occur.
These include hemochromatosis, neuropathy, chondrocalcinosis, alcaptonuria,
hypermobility of joints (including the Ehlers-Danlos syndrome).
There should never be confusionin the differentiation of degenerative joint disease of
the vertebral column from ankylosing spondylitis. Patients with the later are almost

invariably young men, and the roentgenographic features are distinct from those
associated with degenerative joint disease.