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• W2083485452 abstract "In this issue of Osteoarthritis and Cartilage, Dr Pritzker and colleagues1Pritzker K. Gay S. Jimenez S. Ostergaard K. Pelletier J-P. Revell P. Salter D. et al.Osteoarthritis cartilage histopathology: grading and staging.Osteoarthritis Cartilage. 2005; PubMed Google Scholar, under the auspices of the Osteoarthritis Research Society International (OARSI), present a recommended methodology for grading and staging histopathologic changes in osteoarthritic cartilage. As the authors note, the commonly used grading systems developed by Collins et al.2Collins D.H. The pathology of osteoarthritis.Br J Rheumatol. 1939; 1: 248-262Google Scholar, 3Collins D.H. McElligott T.F. Sulphate (35SO4) uptake by chondrocytes in relation to histologic changes in osteoarthritis human articular cartilage.Ann Rheum Dis. 1960; 19: 318-330Crossref PubMed Scopus (161) Google Scholar and Mankin et al.4Mankin H.J. Dorfman H. Lippiello L. Zarins A. Biochemical and metabolic abnormalities in articular cartilage from osteoarthritis human hip. II. Correlations of morphology with biochemical and metabolic data.J Bone Joint Surg Am. 1971; 53: 523-537Crossref PubMed Scopus (1847) Google Scholar, utilized by investigators for decades, have been formally questioned as to reproducibility and validity5Ostergarrd K. Peterson J. Andersen C.B. Bendtzen K. Salter D.M. Histologic/histochemical grading system for osteoarthritis articular cartilage. Reproductively and validity.Arthritis Rheum. 1997; 40: 1766-1771Crossref PubMed Scopus (71) Google Scholar, 6Ostergaard K. Andersen C.B. Petersen J. Bendtzen K. et al.Validity of histopathologic grading of articular from osteoarthritic knee joints.Ann Rheum Dis. 1999; 58: 208-213Crossref PubMed Scopus (88) Google Scholar, 7Van der Sluijs J.A. Geesink R.G.T. Van der Linden A.J. et al.The reliability of Mankin score for osteoarthritis.J Orthop Res. 1992; 10: 58-61Crossref PubMed Scopus (233) Google Scholar. A major deficiency of current scoring systems relates to the difficulty in translating focal pathologic changes into a score that encompasses the overall joint pathologic response. For example, utilizing the Mankin Histological Histochemical Grading System (HHGS), a focal area of cartilage may demonstrate a pathologic composite characterized by cellular changes, loss of Safranin O matrix staining, erosion, and tidemark vessel abnormalities yielding a score of 14 points, the maximal score attainable. In contrast, in another situation, pathologic changes observed may be more superficial, yielding a Mankin score of 5, but with pathologic changes encompassing an extended topographic area; the difficulty equating the two scenarios is readily apparent. Accordingly, the recommendation of the authors that scoring should include both grade and stage promises potential for developing a more accurate and valid comparative scoring methodology. A second deficit in the current scoring systems is the efficacy limitation related to utilizing these methodologic approaches in human studies wherein histopathologic scoring must necessarily be based on small blocks of pathologic tissue available at biopsy. In this situation, scoring using staging as well as grade is difficult. In this scenario, scoring taking into account stage and grade is possible if gross and histologic findings closely correlate, so that histopathologic grades can be validly inferred from gross pathologic findings. An additional issue is the question as to whether histologic progression of osteoarthritis (OA) is the same amongst different animal models (e.g. trauma-induced partial-meniscectomy models vs spontaneous mouse or guinea pig models), and between animal models and humans. The authors have done an admirable job of defining the caveats related to current grading systems, and the hurdles which have to be overcome in defining a new system. In particular, as the authors note, standardization of definitions of OA cartilage histopathology, exclusion criteria for other forms of arthritis, differences between joints and each joint compartment, and methodologies related to histopathologic preparation and staining of standard sections all represent areas which need to be addressed. Of particular import in this regard is standardization of histologic block/section preparation and methodologies for fixation and staining of cartilage. The proposed methods for grading and staging are well defined and, if validated, would represent an advance in histopathologic assessment. Given that staging requires assessment of a whole joint or, at the least, one joint quadrant, such validation will likely necessarily occur first in studies of animal models. Correlations of gross and histopathologic changes are feasible in humans utilizing pathologic materials from individuals undergoing joint replacement whereby gross and histopathologic findings can be correlated. Unfortunately, these studies would reflect late stage disease, not providing information on earlier aspects of the disease process. Although this proposal provides a clearly written treatise comprising background, caveats and recommendations, some questions and comments might be in order. For example, no mention is made of tidemark vascular responses; do the authors believe that these are no longer of import in defining pathology? Table 2, is complex; it might be helpful if the criteria could be separated into those findings required for the grade, and those findings that may be present in addition, described as optional (the authors do provide a ±connotation which might represent such a distinction). Although there may be deficiencies in the Mankin system, depending on whether studies were being performed in animals or in humans, the Mankin system has served us well for many years. Accordingly, the statement that it is “not valid” seems to be a bit strong. In Appendix 2, the glossary is of interest, but might be abbreviated for practical use; in its present form it is probably “more than one needs to know”. In summary, the proposed methodology for grading and staging OA cartilage histopathology represents a significant step forward in addressing advances in an area of methodologic need. The authors provide alternative methods for scoring; it would have been helpful to have presented an opinion as to what method of scoring they would suggest that investigators use at the present time, prior to validation. All investigators interested in studies of OA pathophysiology will appreciate the effort which went into these new recommendations. OARSI, in its leadership role in the field of OA clinical and basic research, is to be commended for its farsightedness in recognizing the need for an advance in this field, and for its sponsorship of the approach. I anticipate that under OARSI guidance validation studies will be expeditiously undertaken to complete the process." @default.
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• W2083485452 title "Osteoarthritis cartilage histopathology: grading and staging" @default.
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