Commentary: is it useful to subset 'primary' osteoarthritis? A critique based on evidence regarding the etiopathogenesis of osteoarthritis.

摘要

We have been invited to comment on the article by Herrero-Beaumont and coworkers (1) in this issue of Seminars in Arthritis and Rheumatism, in which the authors propose that "primary" (that is, idiopathic), common, garden-variety osteoarthritis (OA) can be accounted for by genetic defects, menopause-associated estrogen deficiency, or aging and contend that these 3 subsets possess distinct etiological, clinical, and therapeutic responses. We appreciate the opportunity to do so because we question whether the construction of OA subsets based on that perspective would be of value from either a research or a clinical perspective. Would attempts to use these subsets improve our thinking concerning a biological or pharmacological cure for OA?We examine below the premise raised by Herrero-Beaumont and coworkers in 2 broad sections: (1) Are subsets of OA useful? and (2) The mechanical etiopatho-genesis of common, garden-variety OA, which reviews data we believe overwhelmingly support a mechanical etiopathogenesis of OA.