The reversibility of osteoarthritis: a review

Osteoarthritis, usually considered a wear and tear, or age-associated disease, is generally regarded as inexorably progressive once it has become clinically symptomatic. Enormous advances in the understanding of the normal cell biology of hyaline cartilage, synovium, and bone have led some to suspect that the process can be arrested, or even reversed. Some of the lines of evidence, both experimental and clinical, supporting this proposition, are presented in this paper. I first noted an apparent partial reversal of severe osteoarthritis of the hips in an 85-year-old man, as assessed by reappearance of hip joint spaces, when examined radiologically. The favorable change persisted until his death at age 92. Since then a number of similar cases have been observed, other types of evidence of reversibility examined, and an extensive study of the literature made. Five main areas are described: Modern and ancient concepts of osteoarthritis; myths and misconceptions; theories of etiology and pathogenesis; advances in basic knowledge of tissue involved and lines of evidence of arrest or reversibility derived from these advances; and an outline of practical, clinical management based on the cell biology of hyaline cartilage, synovium, and bone, especially subchondral bone. Aspirin is emphasized as the drug of choice and a method of administration is described.