In a video posted on Instagram, Dr Victoria Tchaikovsky, sports doctor, reiterates a key idea: osteoarthritis is not just a matter of age or worn cartilage. It is a complex joint disease, influenced by several mechanisms.
Osteoarthritis does not only affect cartilage
The formula is simple, but it changes a lot of things in the way we understand the disease:
“Osteoarthritis is not just cartilage that wears away with age.”
Dr. Tchaikovsky explains that the joint is more than just a “cushion” of cartilage. Cartilage is indeed affected, but it is not alone. Osteoarthritis can also involve subchondral bonelocated just under the cartilage, the synovial membrane, and sometimes other structures depending on the joint, such as the menisci or ligaments.
This vision is confirmed by current knowledge: Inserm describes osteoarthritis as a disease which affects the entire joint, and not just mechanical wear of the cartilage. Important nuance: this does not mean that all tissues are affected in the same way in all people. The mechanisms may vary depending on the joint affected, the profile of the person and the history of the joint.
The expert also emphasizes a point that is often overlooked: cartilage is a living tissue, maintained by cells called chondrocytes. Normally, there is a balance between manufacturing, maintenance and degradation of the cartilage matrix. In osteoarthritis, this balance gradually becomes disrupted : degradation mechanisms take over repair mechanisms.
To better understand these mechanisms, you can also consult our article on the mechanisms and different causes of osteoarthritis.
Aging increases the risk, but does not condemn you to osteoarthritis
Age is a major risk factor. With aging, joint tissues can become more vulnerable: certain cells function differently, maintenance capacities decrease, the cartilage matrix changes. Mechanisms such as cellular senescence, oxidative stress or low-grade local inflammation can also contribute to this vulnerability.
But we must avoid too automatic reading.
Getting older does not necessarily mean developing osteoarthritis. Scientific work clearly distinguishes aging and osteoarthritis: they are linked, but are not equivalent. In other words, age increases susceptibility, without being a unique or sufficient cause to explain each situation.
Other factors may be added: an old injury, unusual or repeated mechanical constraints, the anatomy of the joint, genetic or metabolic factors, or even excess weight or obesity. This last point must be understood without feeling guilty: it can increase certain joint constraints and fit into a metabolic context, but
osteoarthritis remains a multifactorial disease.
This is where we must distinguish between association and causation. Having a risk factor does not mean that it alone explains the appearance of the disease. Several elements can be combined, with a different weight depending on the person. To go further, our file on osteoarthritis risk factors details these possible influences.
Inflammation exists, but it is not polyarthritis
Another useful nuance of the video: osteoarthritis is not simply an inflammatory disease, like rheumatoid arthritis can be. On the other hand, chronic local inflammation, often low gradecan participate in its evolution.
Concretely, when joint tissues are altered, the cells can change their behavior. They can produce more enzymes that break down the cartilage matrix, as well as inflammatory mediators. Fragments from damaged tissues can then maintain the local reaction. This can create a vicious circle: degradation, local inflammatory reaction, further degradation.
This mechanism helps to understand why osteoarthritis is not a fatality linked to “cartilage that has been used too much”. It rather corresponds to a progressive imbalance of the jointwhere aging, mechanical stress, metabolic factors and local inflammation intersect.
This understanding obviously does not replace medical advice in the event of pain or joint discomfort, and it does not allow you to decide on treatment alone. Above all, it allows us to move away from a reductive idea: osteoarthritis is not just the normal price of agebut a joint disease in its own right, with multiple mechanisms.