Peripheral Joint Osteoarthritis Research Articles

Experiences with Volumetric Modulated Arc Therapy (VMAT) for treating symptomatic peripheral joint osteoarthritis (OA) with Low Dose Radiotherapy (LDRT) – a case series

Introduction: Peripheral joint osteoarthritis (OA) in Australia is the third leading cause of life-years lost. Implant surgery is a great help, but patients who are waiting or are inoperable suffer. Low Dose Radiotherapy (LDRT) is well established in some countries. Three-dimensional conformal radiotherapy (3DCRT) is recommended. However, some departments may only have Volumetric Modulated Arc Therapy (VMAT). We present our experiences treating ten volumes of symptomatic OA treated with VMAT in nine consecutive patients to two months post-LDRT. Methods: The hypothesis was that LDRT using VMAT was feasible and effective at two months. Patient response data was collected prospectively. The Visual Analog Scale Pain (VASP) for pain was used. A Visual Analog Scale Mobility (VASM) was created for mobility. Bones within radiation oncologists (RO) skin marks around the joint were auto-contoured for clinical target volume (CTV) with 2 mm expansion to planning target volume (PTV). Treatment was titrated to clinical response. Phase 1 was 3 Gray (Gy) in 6 fractions at 2-3 fractions per week. There was RO review at 2 months post-phase 1 for consideration of phase 2. If no response, then phase 2 was 6 Gy in 6 fractions, if a partial response (PR), then a repeat of phase 1. A third phase similar to phase 2 was possible. RO follow-up was done 2 months after the last phase. Results: Nine consecutive patients, eight males and one female, average age of 69 years (60-84), with ten volumes of symptomatic OA were treated. Joints were three single knees, two cases of both knees, three cases of both hands, one hip and one carpometacarpal joint. They had suffered from OA for an average of eight years (1-20). All were on at least one systemic therapy. All were using some sort of local therapy or device. Eight had a PR to phase 1 and proceeded to phase 2. Two had an equivocal response. No patient had a third phase. Average VASP pain scores fell from baseline of 7.4 to 3.6 after phase 1, and to 2.3 after phase 2. Average VASM immobility scores fell from baseline of 6.9 to 4.4 after phase 1 and to 3.3 after phase 2. Conclusion: In this small Australian cohort LDRT using VMAT is feasible and clinically effective when measured at 2 months. More study is needed.

Extracellular vesicles in osteoarthritis of peripheral joint and temporomandibular joint.

Osteoarthritis (OA) is a disabling disease with significant morbidity worldwide. OA attacks the large synovial joint, including the peripheral joints and temporomandibular joint (TMJ). As a representative of peripheral joint OA, knee OA shares similar symptoms with TMJ OA. However, these two joints also display differences based on their distinct development, anatomy, and physiology. Extracellular vesicles (EVs) are phospholipid bilayer nanoparticles, including exosomes, microvesicles, and apoptotic bodies. EVs contain proteins, lipids, DNA, micro-RNA, and mRNA that regulate tissue homeostasis and cell-to-cell communication, which play an essential role in the progression and treatment of OA. They are likely to partake in mechanical response, extracellular matrix degradation, and inflammatory regulation during OA. More evidence has shown that synovial fluid and synovium-derived EVs may serve as OA biomarkers. More importantly, mesenchymal stem cell-derived EV shows a therapeutic effect on OA. However, the different function of EVs in these two joints is largely unknown based on their distinct biological characteristic. Here, we reviewed the effects of EVs in OA progression and compared the difference between the knee joint and TMJ, and summarized their potential therapeutic role in the treatment of OA.

Evaluation of osteoarthritic features in peripheral joints by ultrasound imaging: A systematic review

The role of ultrasound imaging for osteoarthritis (OA) diagnosis in peripheral joints has not been clearly defined. To further understand this role, the objectives of this study were to determine how structural and inflammatory OA features in peripheral joints are assessed, defined and graded by ultrasound imaging. MEDLINE, CINAHL, Cochrane and SPORTDiscus databases were systematically searched in March 2021. To be eligible, studies needed to (1) include participants with peripheral joint OA, and (2) use grey scale and/or power Doppler ultrasound imaging to assess one or more ultrasound features in peripheral joints of the hands and feet. Methodological quality of all included studies was assessed using the Critical Appraisal Skills Program tool [1]. A total of 159 citations were identified for screening. Thirty-two articles were included for final analysis and were of good methodological quality. Thirty articles evaluated ultrasound features of hand OA and two assessed ultrasound OA features in the foot. There were inconsistencies between studies in terms of what ultrasound features were assessed, how these features were defined and what grading system was applied to determine degree of osteoarthritic change. The review found inconsistencies in the definition of synovial pathology. Consequently, it is unclear whether synovial pathology is best represented as separate entities or combined as a single domain, termed “synovitis”. How OA ultrasound features were defined and graded has largely been extrapolated from recommendations originally constructed for populations with rheumatoid arthritis. Given the prognostic value of synovitis for OA progression and that inflammation associated with OA is fundamentally different from that in rheumatoid arthritis [2, 3], the validity of applying definitions, grading systems and atlases originally developed for rheumatoid arthritis needs consideration. This review strengthens the case for further refinement and validation of OA definitions, grading systems and ultrasound atlases specific to peripheral joints.

Pain in focus in patients with osteoarthritis

Introduction. Peripheral joint osteoarthritis is the leading cause of musculoskeletal pain and functional limitation. Osteoarthritis has a high prevalence and incidence and, therefore great socioeconomic importance. Clinical presentation. Pain in osteoarthritis results from a complex interaction of sensory, affective, and cognitive processes that include numerous abnormal cellular mechanisms at the affected joints and different levels of the nervous system involved in the pathophysiological mechanisms of chronic pain (spinal and supraspinal). In chronic pain states, central nervous system factors are particularly prominent. Although there are several ways to determine pain sensitivity, data suggest that assessing pressure pain threshold (i.e., tenderness to palpation) is the most reliable and reproducible method for identifying individuals with a centralized pain state. Conclusion. Significant advances in our understanding of pain pathophysiology and pain biomarkers are finally making the vision of ?personalized analgesia?. Clinicians can identify the sub-sets of individuals with what were once considered purely ?peripheral? pain syndromes and treat these patients with approaches directed more centrally than peripherally.

Assessment of Changes in Concentration of Total Antioxidant Status, Acute-Phase Protein, and Prolactin in Patients with Osteoarthritis Subjected to a Complex Spa Treatment with Radon Water: Preliminary Results.

Spa treatment brings many clinical benefits such as improved physical activity, pain relief, and improved quality of life. In the literature, there are only few objective studies evaluating changes in metabolism possibly influencing clinical outcomes. The main purpose of our study was the assessment of the effect of spa treatment on changes in concentration of TAS, CRP, and PRL in patients with osteoarthritis. Patients receiving spa treatment were enrolled. TAS, CRP, and PRL levels were obtained using standard tests before the beginning of treatment as well as on days 5 and 18. The study group consisted of n = 35 patients with peripheral joint and spinal osteoarthritis. The control group consisted of 15 people selected from the resort staff, who also suffered from osteoarthritis and had no contact with radon. An increase in TAS concentration was found in the study group following therapy while the control group was characterized by a significant decrease in TAS. On day 5, an increase in TAS concentration was found in both groups, however, with much worse result in the control group. No changes in CRP concentration were statistically significant. PRL concentration was proven to decrease in a statistically significant way after treatment in the study group. This trial is registered with NCT03274128.

Nodal knee osteoarthritis and gout incidence, a longitudinal study on the osteoarthritis initiative (OAI) data

Purpose: Gout is the most common inflammatory arthritis and globally affecting 2-5% of the adult population. In addition to well-characterized risk factors for gout incidences, the relationship between gout and osteoarthritis (OA) has been suggested by a few cross-sectional studies. However, the causal relationship between these two medical conditions is yet to be understood, and it is not clear which disease precedes the other. A mounting body of evidence showed that OA, especially its nodal subtype (defined as presence of Heberden’s nodes (HN) in addition to peripheral joint OA), is associated with the metabolic dysregulations, i.e.

A qualitative study of the experiences and perceptions of adults with chronic musculoskeletal conditions following a 12‐week Pilates exercise programme

The aim of the present study was to explore the experiences and perceptions of adult patients with chronic musculoskeletal conditions following a Pilates exercise programme. A qualitative approach was taken to both data collection and analysis, with alignment to the philosophy of interpretive phenomenology. Participants included 15 women and seven men with a range of chronic musculoskeletal conditions, including nonspecific low back pain, peripheral joint osteoarthritis and a range of postsurgical conditions. The age range was from 36years to 83years, and the mean age was 57years (standard deviation 14.1 years). Data were collected via digital recordings of four focus groups in three North-West of England physiotherapy clinics. The data were transcribed verbatim and then analysed using a thematic framework. Data were verified by a researcher and randomly selected participants, and agreement was achieved between all parties. The results were organized into five main themes: physical improvements; Pilates promotes an active lifestyle: improved performance at work and hobbies; psychosocial benefits and improved confidence; increased autonomy in managing their own condition; and motivation to continue with exercise. The study was the first to investigate individual perceptions of the impact of Pilates on the daily lives of people with chronic conditions. The Pilates-based exercise programme enabled the participants to function better and manage their condition more effectively and independently. Further to previous work, the study revealed psychological and social benefits which increase motivation to adhere to the programme and promote a healthier lifestyle.

Osteoarthritis: You can rely on radiography when managing OA, but not too much!

When considering the role of imaging in the management of symptomatic, peripheral joint osteoarthritis (OA) in clinical practice, clinicians should be aware that radiography has its drawbacks, and also consider that the use of advanced imaging techniques such as MRI should not be discouraged.

EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis

The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management...

A systematic review of the relationship between subchondral bone features, pain and structural pathology in peripheral joint osteoarthritis.

IntroductionBone is an integral part of the osteoarthritis (OA) process. We conducted a systematic literature review in order to understand the relationship between non-conventional radiographic imaging of subchondral bone, pain, structural pathology and joint replacement in peripheral joint OA.MethodsA search of the Medline, EMBASE and Cochrane library databases was performed for original articles reporting association between non-conventional radiographic imaging-assessed subchondral bone pathologies and joint replacement, pain or structural progression in knee, hip, hand, ankle and foot OA. Each association was qualitatively characterised by a synthesis of the data from each analysis based upon study design, adequacy of covariate adjustment and quality scoring.ResultsIn total 2456 abstracts were screened and 139 papers were included (70 cross-sectional, 71 longitudinal analyses; 116 knee, 15 hip, six hand, two ankle and involved 113 MRI, eight DXA, four CT, eight scintigraphic and eight 2D shape analyses). BMLs, osteophytes and bone shape were independently associated with structural progression or joint replacement. BMLs and bone shape were independently associated with longitudinal change in pain and incident frequent knee pain respectively.ConclusionSubchondral bone features have independent associations with structural progression, pain and joint replacement in peripheral OA in the hip and hand but especially in the knee. For peripheral OA sites other than the knee, there are fewer associations and independent associations of bone pathologies with these important OA outcomes which may reflect fewer studies; for example the foot and ankle were poorly studied. Subchondral OA bone appears to be a relevant therapeutic target.Systematic reviewPROSPERO registration number: CRD 42013005009Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0735-x) contains supplementary material, which is available to authorized users.

Lumbar spine radiographic features and demographic, clinical, and radiographic knee, hip, and hand osteoarthritis

To determine the prevalence of lumbar spine individual radiographic features (IRFs) of disc space narrowing (DSN), osteophytes (OST), and facet joint osteoarthritis (FOA); to describe the frequencies of demographic, clinical, and radiographic knee, hip, and hand osteoarthritis (OA) across lumbar spine IRFs; and to determine factors associated with lumbar spine IRFs. We conducted a cross-sectional study of 840 participants enrolled in the Johnston County Osteoarthritis Project (2003-2004). Sample-based prevalence estimates were generated for each lumbar spine IRF. The associations between lumbar spine IRFs and demographic, clinical, and peripheral joint OA were determined with logistic regression models. Sample-based prevalence estimates were similar for DSN (57.6%) and FOA (57.9%) but higher for OST (88.1%), with significant differences across race and sex. Hand and knee OA frequencies increased across IRFs, whereas the effect was absent for hip OA. African Americans had lower odds of FOA (adjusted odds ratio [OR(adj) ] 0.45 [95% confidence interval (95% CI) 0.32-0.62]), while there was no racial association with DSN and OST. Low back symptoms were associated with DSN (OR(adj) 1.37 [95% CI 1.04-1.80]) but not OST or FOA. Knee OA was associated with OST (OR(adj) 1.62 [95% CI 1.16-2.27]) and FOA (OR(adj) 1.69 [95% CI 1.15-2.49]) but not DSN. Hand OA was associated with FOA (OR(adj) 1.67 [95% CI 1.20-2.28]) but not with DSN or OST. No associations were found with hip OA. These findings underscore the importance of analyzing lumbar spine IRFs separately as the associations with demographic, clinical, and radiographic knee, hip, and hand OA differ widely.

Pilot randomized controlled trial comparing specific dynamic stability exercises with general exercises for thumb carpometacarpal joint osteoarthritis

Introduction Exercises are widely used and recommended for peripheral joint and hand osteoarthritis (OA); however, the evidence on which specific exercise regimen is most effective is unclear. Methods A pilot randomized controlled trial was conducted to compare the effect of specific first carpometacarpal (CMC) joint stabilizing exercises and general exercise on function, pain and strength. Thirty-nine participants with OA of the first CMC joint were recruited and randomly assigned into one of two exercise groups. Exercises were taught as a home programme then reviewed and only progressed as tolerated. The participant and assessing physiotherapist were blinded. Primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire at three and six months. Pinch and grip strength, pain scores at rest and during pinch and abductor pollicis longus (APL) moment were secondary measures. Results Twenty-two patients completed follow-up at six months. At baseline the general exercise group had significantly stronger pinch and APL moments but was not different in any other measures. The improvement (reduction) of DASH scores at three and six months was not significantly different between the two groups; however, the general exercise group had a greater reduction in DASH score from baseline to three months (13 points P = 0.001). The outcomes were not affected ( P > 0.05) by any variables except APL moment at baseline. Increased APL moment at baseline was associated with an improved outcome in both groups ( P = 0.01). Conclusions While this pilot study was inadequately powered the results can be used to plan a future large-scale trial.

Acupuncture for pain: An overview of Cochrane reviews

Cochrane reviews have the reputation for being more transparent and rigorous than other reviews. The aim of this overview was to evaluate and summarize Cochrane reviews of acupuncture for the treatment of any type of pain. We searched the Cochrane Database and evaluated the Cochrane reviews that were concerned specifically with the effectiveness of acupuncture for pain. Data were extracted according to pre-defined inclusion criteria by two independent reviewers. Eight Cochrane reviews were included. They were all of high methodological quality. They related to a wide range of pain syndromes. Four reviews concluded that acupuncture is effective for migraines, neck disorders, tension-type headaches, and peripheral joint osteoarthritis; one review failed to demonstrate type the effectiveness of acupuncture for rheumatoid arthritis; and three reviews were inconclusive for shoulder pain, lateral elbow pain, and low back pain. Several Cochrane reviews of acupuncture for a wide range of pain conditions have recently been published. All of these reviews were of high quality. Their results suggest that acupuncture is effective for some but not all types of pain.

GDF5 single-nucleotide polymorphism rs143383 is associated with lumbar disc degeneration in Northern European women

ObjectiveLumbar disc degeneration (LDD) is a serious social and medical problem which has been shown to be highly heritable. It has similarities with peripheral joint osteoarthritis (OA) in terms of both epidemiology and pathologic processes. A few known genetic variants have been identified using a candidate gene approach, but many more are thought to exist. GDF5 is a gene whose variants have been shown to play a role in skeletal height as well as predisposing to peripheral joint OA. In vitro, the gene product growth differentiation factor 5 has been shown to promote growth and repair of animal disc. This study was undertaken to investigate whether the GDF5 gene plays a role in LDD.MethodsWe investigated whether the 5′ upstream single-nucleotide polymorphism (SNP) variant rs143383 was associated with LDD, using plain radiography and magnetic resonance imaging to identify disc space narrowing and osteophytes, in 5 population cohorts from Northern Europe.ResultsAn association between LDD and the SNP rs143383 was identified in women, with the same risk allele as in knee and hip OA (odds ratio 1.72 [95% confidence interval 1.15–2.57], P = 0.008).ConclusionOur findings in 5 population cohorts from Northern Europe indicate that a variant in the GDF5 gene is a risk factor for LDD in women. Many more such variants are predicted to exist, but this result highlights the growth and differentiation cellular pathway as a possible route to a better understanding of the process behind lumbar disc degeneration.

Imaging Biomarkers of Spine Osteoarthritis

While there is an acknowledged need for biomarkers to progress arthritis research, imaging biomarkers for the spine have lagged behind those for peripheral joint osteoarthritis. Progress has been slow for a number of reasons. First and perhaps most importantly, there is currently no international agreement on definition of spine osteoarthritis (OA), either histologically or on imaging. Secondly, spine OA comprises two main pathologies, and debate continues as to whether they are separate entities or linked: degenerative disc disease and facet joint arthritis. Imaging those neighbouring joints is not straightforward and usually requires separate imaging investigations. Thirdly, it is only just becoming clear to what extent changes on imaging are associated with the main clinical problem - back pain. To compound the problem, the organisation of clinical services usually means that different specialties tend to focus on different anatomical areas, so a combined approach is not commonly adopted. Systematic evaluation of facet joints in epidemiological study is still in its infancy. Regardless of these hurdles, we have attempted in this review to summarise the state of play of imaging biomarkers in the spine with the emphasis on degenerative disc disease. MR imaging clearly leads the way and there exists a variety of specialist techniques such as T1rho and which may offer spine research imaging biomarkers in the future.

Commentary on the Cochrane Review of Acupuncture for Peripheral Joint Osteoarthritis

The Cochrane Complementary Medicine Field is the group within the Cochrane Collaboration focused on facilitating the conduct of Cochrane systematic reviews of CAM therapies. The CAM Field represents an international collaborative effort among researchers, clinicians, consumers, and CAM practitioners from nearly every continent. The Field's central office is located at the Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207-6697. For more information, contact Eric Manheimer at emanheimer@compmed.umm.edu. The Complementary Medicine Field is supported by grant R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM). The contents of this article are solely the responsibility of the author and do not necessarily represent the official views of the NCCAM or the National Institutes of Health.

Acupuncture for peripheral joint osteoarthritis

Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective. To assess the effects of acupuncture for treating peripheral joint osteoarthritis. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 1), MEDLINE, and EMBASE (both through December 2007), and scanned reference lists of articles. Randomized controlled trials (RCTs) comparing needle acupuncture with a sham, another active treatment, or a waiting list control group in people with osteoarthritis of the knee, hip, or hand. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We calculated standardized mean differences using the differences in improvements between groups. Sixteen trials involving 3498 people were included. Twelve of the RCTs included only people with OA of the knee, 3 only OA of the hip, and 1 a mix of people with OA of the hip and/or knee. In comparison with a sham control, acupuncture showed statistically significant, short-term improvements in osteoarthritis pain (standardized mean difference -0.28, 95% confidence interval -0.45 to -0.11; 0.9 point greater improvement than sham on 20 point scale; absolute percent change 4.59%; relative percent change 10.32%; 9 trials; 1835 participants) and function (-0.28, -0.46 to -0.09; 2.7 point greater improvement on 68 point scale; absolute percent change 3.97%; relative percent change 8.63%); however, these pooled short-term benefits did not meet our predefined thresholds for clinical relevance (i.e. 1.3 points for pain; 3.57 points for function) and there was substantial statistical heterogeneity. Additionally, restriction to sham-controlled trials using shams judged most likely to adequately blind participants to treatment assignment (which were also the same shams judged most likely to have physiological activity), reduced heterogeneity and resulted in pooled short-term benefits of acupuncture that were smaller and non-significant. In comparison with sham acupuncture at the six-month follow-up, acupuncture showed borderline statistically significant, clinically irrelevant improvements in osteoarthritis pain (-0.10, -0.21 to 0.01; 0.4 point greater improvement than sham on 20 point scale; absolute percent change 1.81%; relative percent change 4.06%; 4 trials;1399 participants) and function (-0.11, -0.22 to 0.00; 1.2 point greater improvement than sham on 68 point scale; absolute percent change 1.79%; relative percent change 3.89%). In a secondary analysis versus a waiting list control, acupuncture was associated with statistically significant, clinically relevant short-term improvements in osteoarthritis pain (-0.96, -1.19 to -0.72; 14.5 point greater improvement than sham on 100 point scale; absolute percent change 14.5%; relative percent change 29.14%; 4 trials; 884 participants) and function (-0.89, -1.18 to -0.60; 13.0 point greater improvement than sham on 100 point scale; absolute percent change 13.0%; relative percent change 25.21%). In the head-on comparisons of acupuncture with the 'supervised osteoarthritis education' and the 'physician consultation' control groups, acupuncture was associated with clinically relevant short- and long-term improvements in pain and function. In the head on comparisons of acupuncture with 'home exercises/advice leaflet' and 'supervised exercise', acupuncture was associated with similar treatment effects as the controls. Acupuncture as an adjuvant to an exercise based physiotherapy program did not result in any greater improvements than the exercise program alone. Information on safety was reported in only 8 trials and even in these trials there was limited reporting and heterogeneous methods. Sham-controlled trials show statistically significant benefits; however, these benefits are small, do not meet our pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits, much of which may be due to expectation or placebo effects.

Genetic associations in peripheral joint osteoarthritis and spinal degenerative disease: a systematic review

We conducted a systematic review of genetic association studies for osteoarthritis of the peripheral joints (OA) and spinal degenerative disease (SDD). Electronic searches were carried out for any English language...

Acupuncture for peripheral joint osteoarthritis

To evaluate the evidence for the effectiveness of acupuncture in peripheral joint osteoarthritis (OA).Systematic searches were conducted on Medline, Embase, AMED, Cochrane Library, CINAHL, British Nursing Index, PsychINFO and CAMPAIN until July 2005. Hand-searches included conference proceedings and our own files. There were no restrictions regarding the language of publication. All randomized controlled trials (RCTs) of acupuncture for patients with peripheral joint OA were considered for inclusion. Trials assessing needle acupuncture with or without electrical stimulation were considered if sham- or placebo-controlled or controlled against a comparator intervention. Trials testing other forms of acupuncture were excluded. Methodological quality was assessed and, where possible, meta-analyses were performed.Thirty-one possibly relevant studies were identified and 18 RCTs were included. Ten trials tested manual acupuncture and eight trials tested electro-acupuncture. Overall, ten studies demonstrated greater pain reduction in acupuncture groups compared with controls. The meta-analysis of homogeneous data showed a significant effect of manual acupuncture compared with sham acupuncture (standardized mean difference 0.24, 95% confidence interval 0.01-0.47, P = 0.04, n = 329), which is supported by data for knee OA. The extent of heterogeneity in trials of electro-acupuncture prevented a meaningful meta-analysis.Sham-controlled RCTs suggest specific effects of acupuncture for pain control in patients with peripheral joint OA. Considering its favourable safety profile acupuncture seems an option worthy of consideration particularly for knee OA. Further studies are required particularly for manual or electro-acupuncture in hip OA.

Degenerative joint disease in African great apes: an evolutionary perspective

Degenerative joint disease is investigated in the spine and major peripheral joints (shoulder, elbow, hip and knee) in samples of chimpanzees (Pan troglodytes schweinfurthii; P. troglodytes troglodytes), lowland gorillas (Gorilla gorilla gorilla), and bonobos (P. paniscus). The P. troglodytes schweinfurthii sample comes from Gombe National Park, Tanzania, while the other samples are derived from museum materials originally collected in west/central Africa. Total data for African ape samples include 5807 surfaces for ascertainment of vertebral osteophytosis, 12,479 surfaces for determination of spinal osteoarthritis, and 1211 joints for evaluation of peripheral joint osteoarthritis. All apes display significantly less spinal disease than in a comparable human sample, and these differences are most likely a consequence of human biomechanical adaptations for bipedal locomotion. Apes are also generally less involved in the major peripheral joints than are humans, but human groups are themselves highly variable in prevalence of peripheral osteoarthritis. These data agree with other findings of low prevalence of degenerative joint prevalence in free-ranging apes, but contrast markedly with evidence derived from colony-reared Old World monkeys.