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Are osteophytes good or bad?

  • C-J. Menkes
    Affiliations
    Université René Descartes, Hôpital Cochin, 27 rue du Faubourg Saint Jacques, 75014 Paris France
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  • N.E. Lane
    Correspondence
    Address correspondence to: Nancy E. Lane, MD, Associate Professor of Medicine, Division of Rheumatology, Box 0868, University of California at San Francisco, San Francisco, California 94143. Tel.: +1-415-206-8189; Fax: +1-415-648-8425
    Affiliations
    Division of Rheumatology, University of California at San Francisco, San Francisco, California 94143, USA
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      Keywords

      There are three types of osteophytes: the traction spur, a physiologic response at the insertion of tendons and ligaments; the inflammatory spur, represented by the syndesmophyte at the insertion of ligaments and tendons to bone as seen in ankylosing spondylitis; and the real osteophyte – or better, osteochondrophyte – arising in the synovium overlying bone at the junctional zone. The osteochondrophyte is believed to form from metaplasia of synovium into cartilage with the formation of chondroblasts and cartilage at the margin of articular surface
      • Alexander C.J.
      Osteoarthritis: a review of old myths and current concepts.
      • Moskowitz R.
      Bone remodeling in osteoarthritis: subchondral and osteophytic responses.
      • Oni O.O.
      • Boyd I.
      The origin of the periarticular osteophytes of osteoarthritic knee joints.

      Moskowitz RW, Goldberg VM. Osteophyte evolution:studies in an experimental partial meniscectomy model. J Rheumatol 1987;14:166-8.

      .
      The osteophyte myth is represented by the supposed diagnostic relevance of tibial spine hypertrophy. In reality, tibial spines are not ligamentous insertions or traction spurs, and the peaking of the tibial spines is not a relevant diagnostic finding
      • Alexander C.J.
      Osteoarthritis: a review of old myths and current concepts.
      . The osteophytes can be considered to be an adaptive reaction of the joint to cope with instability. Osteophytes splint the joint and may play a compensatory role in the redistribution of forces to provide articular cartilage protection. It has been shown, at the time of total knee replacement, that removal of osteophytes from the arthritic compartment significantly increased the varus-valgus motion, and subsequent removal of osteophytes from the nonosteoarthritic compartment further increased motion. Therefore, these data suggest that osteophytes appear to stabilize osteoarthritic knees but can cause fixed deformity
      • Pottenger L.A.
      • Phillips F.M.
      • Draganich L.F.
      The effect of marginal osteophytes on reduction of varus-valgus instability in osteoarthritic knees.
      .
      The formation of osteophytes is linked to growth factors. Uchino et al.
      • Uchino M.
      • Izumi T.
      • Tominaga T.
      • Wakita R.
      • Minchara H.
      • Sekiguchi M.
      • et al.
      Growth factor expression in the osteophytes of the human femoral head in osteoarthritis.
      demonstrated that both transforming growth factor-β1 (TGF-β1) and basic fibroblast growth factor (bFGF) are expressed in osteophytes of the femoral head in osteoarthritis (OA). In a murine model of OA, osteophytes develop after repeated injections of TGF-β1 in the knee and after sustained overexpression of TGF-β in the joint following TGF-β gene transfer
      • Van den Berg W.B.
      Osteophyte formation in osteoarthritis.
      • Van Beuningen H.M.
      • Glansbeek H.L.
      • Van der Kraan P.M.
      • Van den Berg W.B.
      Osteoarthritis-like changes in the murine knee joint resulting from intra-articular transforming growth factor-beta injections.
      . Interestingly, cartilage lesions are correlated with the degree of osteophyte formation. A few studies have shown that bone scintigraphy is a good marker for growing, active osteophytes and may predict, to some extent, the future disintegration of the joint
      • Van Osch G.J.
      • Van der Kraan P.M.
      • Van Valburg A.A.
      • Van den Berg W.B.
      The relation between cartilage damage and osteophyte size in a murine model for osteoarthritis in the knee.
      • Dieppe P.A.
      • Cushnagan J.
      • Young P.
      • Kirwan J.
      Bone scintigraphy predicts the progression of joint space narrowing in osteoarthritis of the knee.
      .
      Clinically, osteophytes of the knee are associated with pain and predict pain more accurately than the narrowing of knee joint space in all radiological views
      • Cicuttini F.M.
      • Baker J.
      • Hart D.J.
      • Spector T.D.
      Association of pain with radiological changes in different compartments and views of the knee joint.
      .
      The clinical aspects of osteophytes in OA are summarized by K. Brandt
      • Brandt K.D.
      Osteophytes in osteoarthritis. Clinical aspects.
      . According to Dr Brandt, antiresorptive drugs inhibit the formation of cancellous subchondral bone but have no effect on the formation of marginal osteophytes. Doxycycline has no effect on osteophytes, but some anti-inflammatory drugs, such as glucocorticoids that have an anti-anabolic effect, inhibit both cartilage breakdown and osteophytosis
      • Yu L.P.
      • Smith Jr., G.N.
      • Brandt K.D.
      • Myers S.L.
      • O’Connor B.L.
      • Brandt D.A.
      Reduction of the severity of canine osteoarthritis by prophylactic treatment with oral doxycycline.
      • Pelletier J.P.
      • Martel-Pelletier J.
      Protective effects of corticosteroids on cartilage lesions and osteophyte formation in the Pond-Nuki dog model of osteoarthritis.
      • Devogelaer J.P.
      • Manicourt D.H.
      Osteophytes and osteoarthritis progression. Effects of nonsteroidalantiinflammatory drugs.
      .
      However, osteophytes may represent a manifestation of aging in the absence of other bony changes. In most cases, they are asymptomatic, but they may be of clinical importance. For instance, cervical osteophytes may cause dysphagia, and lumbar osteophytes may be responsible for nerve root compression with severe pain, requiring surgical removal
      • Strasser G.
      • Schima W.
      • Schober E.
      • Pokieser P.
      • Kaider A.
      • Denk D.H.
      Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration.
      • Lamer T.J.
      Lumbar spine pain originating from vertebral osteophytes.
      .
      Does the removal of osteophytes accelerate cartilage degeneration? Surgeons have shown that after hallux rigidus cheilectomy there is no cartilage destruction
      • Mann R.A.
      • Clanton T.O.
      Hallux rigidus: treatment by cheilectomy.
      . Are osteophytes good or bad? It depends where they are situated, and it depends on the stage of the disease. At the endstage of OA in lower limbs they may be good because they stabilize the joint. However, in the spine, most often, they are painful, and they are bad.

      1. Discussion

      Participant: Magnetic resonance imaging (MRI) can provide interesting information with regard to the evolution of osteophytes. As osteophytes evolve, one will typically see some focal hyperemic or an edema pattern on an MRI scan. And then, as they mature, they can have a low signal if they are densely ossified, or even in a late stage, as one may see bone marrow replacement going into the osteophyte. It might be interesting to determine from both longitudinal and cross-sectional studies the value of MRI in showing the relationship between osteophytes and the stage of the disease, the symptoms of disease, and drug efficacy.
      Dr Menkes: The value of MRI is confirmed by the findings in patients who, for some reason, underwent both bone scintigraphy and MRI at the same time. An increased uptake of the radioisotope on the bone scan and a gadolinium-enhanced imaging on the MRI, corresponding to a local hyperactivity, appear to be correlated.
      Participant: If we accept that osteophytes are the joint’s attempt to stabilize joint instability introduced by the osteoarthritic process, there should be some correlation between the size or the growth of the osteophyte and other criteria of joint change, such as loss of joint space or the size of the focal lesions. Do you know whether anyone has tried to correlate these or other parameters with the rate of progression of osteophyte formation?
      Dr Dougados: In the ECHODIAH study, we evaluated radiographic data from 500 patients with hip OA in an effort to determine the radiographic findings that would predispose patients to disease progression. Progression was defined by the change in joint space width after 2 years. The radiological factors found to be predisposing factors for disease progression were the presence at baseline of subchondral cysts, osteosclerosis, and osteophytes. We found that the absence of osteophytes was associated with a higher risk of progression.
      It is possible that the absence of osteophytes is characteristic of a specific group of patients with rapidly destructive OA of the hip. When collecting information about osteophytes, it is interesting to take into account other localizations of the disease.
      Dr Buckland-Wright: I wonder if this is not something that has been described previously, by the South African surgeons, who characterized the atrophic and hypertrophic forms of OA. The atrophic form, which is non-osteophyte forming, is highly destructive with rapid progression, and the hypertrophic form is osteophyte forming with a low rate of progression.

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        Osteoarthritis: a review of old myths and current concepts.
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        Bone remodeling in osteoarthritis: subchondral and osteophytic responses.
        Osteoarthritis Cartilage. 1999; 7: 323-324
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        • Boyd I.
        The origin of the periarticular osteophytes of osteoarthritic knee joints.
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        The effect of marginal osteophytes on reduction of varus-valgus instability in osteoarthritic knees.
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        • Izumi T.
        • Tominaga T.
        • Wakita R.
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        • et al.
        Growth factor expression in the osteophytes of the human femoral head in osteoarthritis.
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        Osteophyte formation in osteoarthritis.
        Osteoarthritis Cartilage. 1999; 7: 333
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        • Glansbeek H.L.
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        Osteoarthritis-like changes in the murine knee joint resulting from intra-articular transforming growth factor-beta injections.
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        The relation between cartilage damage and osteophyte size in a murine model for osteoarthritis in the knee.
        Rheumatol Int. 1996; 16: 115-119
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        Bone scintigraphy predicts the progression of joint space narrowing in osteoarthritis of the knee.
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        Association of pain with radiological changes in different compartments and views of the knee joint.
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        Osteophytes in osteoarthritis. Clinical aspects.
        Osteoarthritis Cartilage. 1999; 7: 334-335
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        Reduction of the severity of canine osteoarthritis by prophylactic treatment with oral doxycycline.
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        Protective effects of corticosteroids on cartilage lesions and osteophyte formation in the Pond-Nuki dog model of osteoarthritis.
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        • Manicourt D.H.
        Osteophytes and osteoarthritis progression. Effects of nonsteroidalantiinflammatory drugs.
        Osteoarthritis Cartilage. 1999; 7: 336-337
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        • Schima W.
        • Schober E.
        • Pokieser P.
        • Kaider A.
        • Denk D.H.
        Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration.
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        Lumbar spine pain originating from vertebral osteophytes.
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