UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Risk factors for and possible causes of osteoarthritis

Author
Kenneth C Kalunian, MD
Section Editor
Peter Tugwell, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

Osteoarthritis (OA) was previously thought to be a normal consequence of aging, thereby leading to the term degenerative joint disease. However, it is now realized that OA results from a complex interplay of multiple factors, including joint integrity, genetics, local inflammation, mechanical forces, and cellular and biochemical processes [1]. A discussion of how these factors interact to cause cartilage loss and related bony changes is presented separately. (See "Pathogenesis of osteoarthritis".)

Rarely, inherited conditions may predispose individuals to develop OA. For the majority of patients, OA is linked to one or more factors, such as aging, occupation, trauma, and repetitive, small insults over time. These associations are strongest for OA of the knee and hand and are less strong for the hip. How these factors interact with genetics and other factors in the development of OA remains unclear.

The risk factors for and possible causes of OA will be reviewed here. Clinical manifestations, classification, and diagnosis are presented separately. (See "Clinical manifestations and diagnosis of osteoarthritis".)

The management of OA, including nonpharmacologic approaches, pharmacologic treatment, and surgical therapies, is discussed separately. (See "Nonpharmacologic therapy of osteoarthritis" and "Initial pharmacologic therapy of osteoarthritis" and "Overview of surgical therapy of knee and hip osteoarthritis".)

RISK FACTORS AND POSSIBLE CAUSES

Multiple risk factors have been linked to osteoarthritis (OA) in epidemiology studies, including:

                                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Jun 18 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Creamer P, Hochberg MC. Osteoarthritis. Lancet 1997; 350:503.
  2. Brandt K. Osteoarthritis: Clinical patterns and pathology. In: Textbook of Rheumatology, Fifth Edition, Kelley WN, Harris ED Jr, Ruddy S, Sledge CE (Eds), W.B. Saunders, Philadelphia 1997. p.1383.
  3. Jordan JM, Luta G, Renner JB, et al. Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of sociodemographic factors, obesity, and knee pain. Arthritis Care Res 1996; 9:273.
  4. Heliövaara M, Mäkelä M, Impivaara O, et al. Association of overweight, trauma and workload with coxarthrosis. A health survey of 7,217 persons. Acta Orthop Scand 1993; 64:513.
  5. Felson DT, Zhang Y, Anthony JM, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 1992; 116:535.
  6. Hartz AJ, Fischer ME, Bril G, et al. The association of obesity with joint pain and osteoarthritis in the HANES data. J Chronic Dis 1986; 39:311.
  7. Lawrence JS, Bremner JM, Bier F. Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 1966; 25:1.
  8. Davis MA, Ettinger WH, Neuhaus JM, Hauck WW. Sex differences in osteoarthritis of the knee. The role of obesity. Am J Epidemiol 1988; 127:1019.
  9. Maillefert JF, Gueguen A, Monreal M, et al. Sex differences in hip osteoarthritis: results of a longitudinal study in 508 patients. Ann Rheum Dis 2003; 62:931.
  10. Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. Am J Epidemiol 1988; 128:179.
  11. Felson DT, Anderson JJ, Naimark A, et al. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med 1988; 109:18.
  12. KELLGREN JH. Osteoarthrosis in patients and populations. Br Med J 1961; 2:1.
  13. Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol 1993; 20:331.
  14. Spector TD, Hart DJ, Doyle DV. Incidence and progression of osteoarthritis in women with unilateral knee disease in the general population: the effect of obesity. Ann Rheum Dis 1994; 53:565.
  15. Vingård E. Overweight predisposes to coxarthrosis. Body-mass index studied in 239 males with hip arthroplasty. Acta Orthop Scand 1991; 62:106.
  16. Kraus JF, D'Ambrosia RD, Smith EG, et al. An epidemiological study of severe osteoarthritis. Orthopedics 1978; 1:37.
  17. Saville PD, Dickson J. Age and weight in osteoarthritis of the hip. Arthritis Rheum 1968; 11:635.
  18. Losina E, Walensky RP, Reichmann WM, et al. Impact of obesity and knee osteoarthritis on morbidity and mortality in older Americans. Ann Intern Med 2011; 154:217.
  19. Hart DJ, Doyle DV, Spector TD. Incidence and risk factors for radiographic knee osteoarthritis in middle-aged women: the Chingford Study. Arthritis Rheum 1999; 42:17.
  20. McAlindon TE, Wilson PW, Aliabadi P, et al. Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med 1999; 106:151.
  21. Felson DT, Niu J, Clancy M, et al. Effect of recreational physical activities on the development of knee osteoarthritis in older adults of different weights: the Framingham Study. Arthritis Rheum 2007; 57:6.
  22. Nguyen US, Zhang Y, Zhu Y, et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med 2011; 155:725.
  23. Karlson EW, Mandl LA, Aweh GN, et al. Total hip replacement due to osteoarthritis: the importance of age, obesity, and other modifiable risk factors. Am J Med 2003; 114:93.
  24. Flugsrud GB, Nordsletten L, Espehaug B, et al. The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: a cohort study in 1.2 million persons. Arthritis Rheum 2006; 54:802.
  25. Gelber AC, Hochberg MC, Mead LA, et al. Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. Am J Med 1999; 107:542.
  26. Lindsay R. Estrogen deficiency. In: Osteoporosis: Etiology, Diagnosis, and Management, Second Edition, Riggs BL, Melton LJ (Eds), Lippincott-Raven Publishers, 1995. p.133.
  27. Cooper C, Cook PL, Osmond C, et al. Osteoarthritis of the hip and osteoporosis of the proximal femur. Ann Rheum Dis 1991; 50:540.
  28. Nevitt MC, Lane NE, Scott JC, et al. Radiographic osteoarthritis of the hip and bone mineral density. The Study of Osteoporotic Fractures Research Group. Arthritis Rheum 1995; 38:907.
  29. Hart DJ, Mootoosamy I, Doyle DV, Spector TD. The relationship between osteoarthritis and osteoporosis in the general population: the Chingford Study. Ann Rheum Dis 1994; 53:158.
  30. Zhang Y, Hannan MT, Chaisson CE, et al. Bone mineral density and risk of incident and progressive radiographic knee osteoarthritis in women: the Framingham Study. J Rheumatol 2000; 27:1032.
  31. Rosner IA, Goldberg VM, Moskowitz RW. Estrogens and osteoarthritis. Clin Orthop Relat Res 1986; :77.
  32. Tsai CL, Liu TK. Estradiol-induced knee osteoarthrosis in ovariectomized rabbits. Clin Orthop Relat Res 1993; :295.
  33. SILBERBERG M, SILBERBERG R. Modifying action of estrogen on the evolution of osteoarthrosis in mice of different ages. Endocrinology 1963; 72:449.
  34. Turner AS, Athanasiou KA, Zhu CF, et al. Biochemical effects of estrogen on articular cartilage in ovariectomized sheep. Osteoarthritis Cartilage 1997; 5:63.
  35. Hannan MT, Felson DT, Anderson JJ, et al. Estrogen use and radiographic osteoarthritis of the knee in women. The Framingham Osteoarthritis Study. Arthritis Rheum 1990; 33:525.
  36. Samanta A, Jones A, Regan M, et al. Is osteoarthritis in women affected by hormonal changes or smoking? Br J Rheumatol 1993; 32:366.
  37. Nevitt MC, Cummings SR, Lane NE, et al. Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 1996; 156:2073.
  38. Felson DT, Zhang Y, Hannan MT, et al. The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1995; 38:1500.
  39. Oliveria SA, Felson DT, Klein RA, et al. Estrogen replacement therapy and the development of osteoarthritis. Epidemiology 1996; 7:415.
  40. Nevitt MC, Felson DT, Williams EN, Grady D. The effect of estrogen plus progestin on knee symptoms and related disability in postmenopausal women: The Heart and Estrogen/Progestin Replacement Study, a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2001; 44:811.
  41. Cooper C, McAlindon T, Coggon D, et al. Occupational activity and osteoarthritis of the knee. Ann Rheum Dis 1994; 53:90.
  42. Felson DT. The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum 1990; 20:42.
  43. Zhang Y, Hunter DJ, Nevitt MC, et al. Association of squatting with increased prevalence of radiographic tibiofemoral knee osteoarthritis: the Beijing Osteoarthritis Study. Arthritis Rheum 2004; 50:1187.
  44. Coggon D, Croft P, Kellingray S, et al. Occupational physical activities and osteoarthritis of the knee. Arthritis Rheum 2000; 43:1443.
  45. Croft P, Cooper C, Wickham C, Coggon D. Osteoarthritis of the hip and occupational activity. Scand J Work Environ Health 1992; 18:59.
  46. Yoshimura N, Sasaki S, Iwasaki K, et al. Occupational lifting is associated with hip osteoarthritis: a Japanese case-control study. J Rheumatol 2000; 27:434.
  47. Panush RS. Does exercise cause arthritis? Long-term consequences of exercise on the musculoskeletal system. Rheum Dis Clin North Am 1990; 16:827.
  48. Lane NE. Exercise: a cause of osteoarthritis. J Rheumatol Suppl 1995; 43:3.
  49. Murphy SB, Ganz R, Müller ME. The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995; 77:985.
  50. Jacobsen S, Sonne-Holm S. Hip dysplasia: a significant risk factor for the development of hip osteoarthritis. A cross-sectional survey. Rheumatology (Oxford) 2005; 44:211.
  51. Reijman M, Hazes JM, Pols HA, et al. Acetabular dysplasia predicts incident osteoarthritis of the hip: the Rotterdam study. Arthritis Rheum 2005; 52:787.
  52. McDermott M, Freyne P. Osteoarthrosis in runners with knee pain. Br J Sports Med 1983; 17:84.
  53. von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 2004; 63:269.
  54. Boszotta H, Helperstorfer W, Kölndorfer G, et al. [Long-term results of arthroscopic meniscectomy]. Aktuelle Traumatol 1994; 24:30.
  55. Neyret P, Donell ST, Dejour H. Osteoarthritis of the knee following meniscectomy. Br J Rheumatol 1994; 33:267.
  56. Hill CL, Seo GS, Gale D, et al. Cruciate ligament integrity in osteoarthritis of the knee. Arthritis Rheum 2005; 52:794.
  57. Doherty M, Watt I, Dieppe P. Influence of primary generalised osteoarthritis on development of secondary osteoarthritis. Lancet 1983; 2:8.
  58. Englund M, Paradowski PT, Lohmander LS. Association of radiographic hand osteoarthritis with radiographic knee osteoarthritis after meniscectomy. Arthritis Rheum 2004; 50:469.
  59. Hunter DJ, Zhang YQ, Niu JB, et al. The association of meniscal pathologic changes with cartilage loss in symptomatic knee osteoarthritis. Arthritis Rheum 2006; 54:795.
  60. Berthiaume MJ, Raynauld JP, Martel-Pelletier J, et al. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 2005; 64:556.
  61. Burke MJ, Roman V, Wright V. Bone and joint changes in lower limb amputees. Ann Rheum Dis 1978; 37:252.
  62. Melzer I, Yekutiel M, Sukenik S. Comparative study of osteoarthritis of the contralateral knee joint of male amputees who do and do not play volleyball. J Rheumatol 2001; 28:169.
  63. Fisher NM, Kame VD Jr, Rouse L, Pendergast DR. Quantitative evaluation of a home exercise program on muscle and functional capacity of patients with osteoarthritis. Am J Phys Med Rehabil 1994; 73:413.
  64. Slemenda C, Brandt KD, Heilman DK, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med 1997; 127:97.
  65. Thorstensson CA, Petersson IF, Jacobsson LT, et al. Reduced functional performance in the lower extremity predicted radiographic knee osteoarthritis five years later. Ann Rheum Dis 2004; 63:402.
  66. Sharma L, Dunlop DD, Cahue S, et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Ann Intern Med 2003; 138:613.
  67. Chaisson CE, Zhang Y, Sharma L, et al. Grip strength and the risk of developing radiographic hand osteoarthritis: results from the Framingham Study. Arthritis Rheum 1999; 42:33.
  68. Buckwalter JA. Osteoarthritis and articular cartilage use, disuse, and abuse: experimental studies. J Rheumatol Suppl 1995; 43:13.
  69. Sharma L, Pai YC. Impaired proprioception and osteoarthritis. Curr Opin Rheumatol 1997; 9:253.
  70. Wordsworth P. Genes and arthritis. Br Med Bull 1995; 51:249.
  71. Holderbaum D, Haqqi TM, Moskowitz RW. Genetics and osteoarthritis: exposing the iceberg. Arthritis Rheum 1999; 42:397.
  72. Bijkerk C, Houwing-Duistermaat JJ, Valkenburg HA, et al. Heritabilities of radiologic osteoarthritis in peripheral joints and of disc degeneration of the spine. Arthritis Rheum 1999; 42:1729.
  73. Ingvarsson T, Stefánsson SE, Hallgrímsdóttir IB, et al. The inheritance of hip osteoarthritis in Iceland. Arthritis Rheum 2000; 43:2785.
  74. Spector TD, Cicuttini F, Baker J, et al. Genetic influences on osteoarthritis in women: a twin study. BMJ 1996; 312:940.
  75. MacGregor AJ, Antoniades L, Matson M, et al. The genetic contribution to radiographic hip osteoarthritis in women: results of a classic twin study. Arthritis Rheum 2000; 43:2410.
  76. Sambrook PN, MacGregor AJ, Spector TD. Genetic influences on cervical and lumbar disc degeneration: a magnetic resonance imaging study in twins. Arthritis Rheum 1999; 42:366.
  77. Jonsson H, Manolescu I, Stefansson SE, et al. The inheritance of hand osteoarthritis in Iceland. Arthritis Rheum 2003; 48:391.
  78. Demissie S, Cupples LA, Myers R, et al. Genome scan for quantity of hand osteoarthritis: the Framingham Study. Arthritis Rheum 2002; 46:946.
  79. Hunter DJ, Demissie S, Cupples LA, et al. A genome scan for joint-specific hand osteoarthritis susceptibility: The Framingham Study. Arthritis Rheum 2004; 50:2489.
  80. Chapman K, Mustafa Z, Irven C, et al. Osteoarthritis-susceptibility locus on chromosome 11q, detected by linkage. Am J Hum Genet 1999; 65:167.
  81. Chapman K, Mustafa Z, Dowling B, et al. Finer linkage mapping of primary hip osteoarthritis susceptibility on chromosome 11q in a cohort of affected female sibling pairs. Arthritis Rheum 2002; 46:1780.
  82. Forster T, Chapman K, Marcelline L, et al. Finer linkage mapping of primary osteoarthritis susceptibility loci on chromosomes 4 and 16 in families with affected women. Arthritis Rheum 2004; 50:98.
  83. Livshits G, Kato BS, Zhai G, et al. Genomewide linkage scan of hand osteoarthritis in female twin pairs showing replication of quantitative trait loci on chromosomes 2 and 19. Ann Rheum Dis 2007; 66:623.
  84. Stefánsson SE, Jónsson H, Ingvarsson T, et al. Genomewide scan for hand osteoarthritis: a novel mutation in matrilin-3. Am J Hum Genet 2003; 72:1448.
  85. Spector TD, Reneland RH, Mah S, et al. Association between a variation in LRCH1 and knee osteoarthritis: a genome-wide single-nucleotide polymorphism association study using DNA pooling. Arthritis Rheum 2006; 54:524.
  86. Marks JS, Stewart IM, Hardinge K. Primary osteoathrosis of the hip and Heberden's nodes. Ann Rheum Dis 1979; 38:107.
  87. Pattrick M, Manhire A, Ward AM, Doherty M. HLA-A, B antigens and alpha 1-antitrypsin phenotypes in nodal generalised osteoarthritis and erosive osteoarthritis. Ann Rheum Dis 1989; 48:470.
  88. Brodsky A, Appelboom T, Govaerts A, Famaey JP. [HLA antigens and Heberden nodes (author's transl)]. Acta Rhumatol Belg 1979; 3:95.
  89. Ercilla MG, Brancos MA, Breysse Y, et al. HLA antigens in Forestier's disease, ankylosing spondylitis, and polyarthrosis of the hands. J Rheumatol Suppl 1977; 3:89.
  90. Benavides G, Cervantes A, Silva B, et al. HLA and Heberden's nodes in Mexican Mestizos. Clin Rheumatol 1985; 4:97.
  91. Palotie A, Väisänen P, Ott J, et al. Predisposition to familial osteoarthrosis linked to type II collagen gene. Lancet 1989; 1:924.
  92. Knowlton RG, Katzenstein PL, Moskowitz RW, et al. Genetic linkage of a polymorphism in the type II procollagen gene (COL2A1) to primary osteoarthritis associated with mild chondrodysplasia. N Engl J Med 1990; 322:526.
  93. Ala-Kokko L, Baldwin CT, Moskowitz RW, Prockop DJ. Single base mutation in the type II procollagen gene (COL2A1) as a cause of primary osteoarthritis associated with a mild chondrodysplasia. Proc Natl Acad Sci U S A 1990; 87:6565.
  94. Vikkula M, Palotie A, Ritvaniemi P, et al. Early-onset osteoarthritis linked to the type II procollagen gene. Detailed clinical phenotype and further analyses of the gene. Arthritis Rheum 1993; 36:401.
  95. Uitterlinden AG, Burger H, van Duijn CM, et al. Adjacent genes, for COL2A1 and the vitamin D receptor, are associated with separate features of radiographic osteoarthritis of the knee. Arthritis Rheum 2000; 43:1456.
  96. Sahlman J, Pitkänen MT, Prockop DJ, et al. A human COL2A1 gene with an Arg519Cys mutation causes osteochondrodysplasia in transgenic mice. Arthritis Rheum 2004; 50:3153.
  97. Su P, Li R, Liu S, et al. Age at onset-dependent presentations of premature hip osteoarthritis, avascular necrosis of the femoral head, or Legg-Calvé-Perthes disease in a single family, consequent upon a p.Gly1170Ser mutation of COL2A1. Arthritis Rheum 2008; 58:1701.
  98. Kizawa H, Kou I, Iida A, et al. An aspartic acid repeat polymorphism in asporin inhibits chondrogenesis and increases susceptibility to osteoarthritis. Nat Genet 2005; 37:138.
  99. Mustafa Z, Dowling B, Chapman K, et al. Investigating the aspartic acid (D) repeat of asporin as a risk factor for osteoarthritis in a UK Caucasian population. Arthritis Rheum 2005; 52:3502.
  100. Loughlin J, Sinsheimer JS, Mustafa Z, et al. Association analysis of the vitamin D receptor gene, the type I collagen gene COL1A1, and the estrogen receptor gene in idiopathic osteoarthritis. J Rheumatol 2000; 27:779.
  101. Keen RW, Hart DJ, Lanchbury JS, Spector TD. Association of early osteoarthritis of the knee with a Taq I polymorphism of the vitamin D receptor gene. Arthritis Rheum 1997; 40:1444.
  102. Uitterlinden AG, Burger H, Huang Q, et al. Vitamin D receptor genotype is associated with radiographic osteoarthritis at the knee. J Clin Invest 1997; 100:259.
  103. Ushiyama T, Ueyama H, Inoue K, et al. Estrogen receptor gene polymorphism and generalized osteoarthritis. J Rheumatol 1998; 25:134.
  104. Bergink AP, van Meurs JB, Loughlin J, et al. Estrogen receptor alpha gene haplotype is associated with radiographic osteoarthritis of the knee in elderly men and women. Arthritis Rheum 2003; 48:1913.
  105. Jordan KM, Syddall H, Dennison EM, et al. Birthweight, vitamin D receptor gene polymorphism, and risk of lumbar spine osteoarthritis. J Rheumatol 2005; 32:678.
  106. Ross JM, Kowalchuk RM, Shaulinsky J, et al. Association of heterozygous hemochromatosis C282Y gene mutation with hand osteoarthritis. J Rheumatol 2003; 30:121.
  107. Meulenbelt I, Seymour AB, Nieuwland M, et al. Association of the interleukin-1 gene cluster with radiographic signs of osteoarthritis of the hip. Arthritis Rheum 2004; 50:1179.
  108. Valdes AM, Van Oene M, Hart DJ, et al. Reproducible genetic associations between candidate genes and clinical knee osteoarthritis in men and women. Arthritis Rheum 2006; 54:533.
  109. Min JL, Meulenbelt I, Riyazi N, et al. Association of the Frizzled-related protein gene with symptomatic osteoarthritis at multiple sites. Arthritis Rheum 2005; 52:1077.
  110. Lane NE, Lian K, Nevitt MC, et al. Frizzled-related protein variants are risk factors for hip osteoarthritis. Arthritis Rheum 2006; 54:1246.
  111. STICKLER GB, BELAU PG, FARRELL FJ, et al. HEREDITARY PROGRESSIVE ARTHRO-OPHTHALMOPATHY. Mayo Clin Proc 1965; 40:433.
  112. Rai A, Wordsworth P, Coppock JS, et al. Hereditary arthro-ophthalmopathy (Stickler syndrome): a diagnosis to consider in familial premature osteoarthritis. Br J Rheumatol 1994; 33:1175.
  113. Francomano CA, Liberfarb RM, Hirose T, et al. The Stickler syndrome: evidence for close linkage to the structural gene for type II collagen. Genomics 1987; 1:293.
  114. Knowlton RG, Weaver EJ, Struyk AF, et al. Genetic linkage analysis of hereditary arthro-ophthalmopathy (Stickler syndrome) and the type II procollagen gene. Am J Hum Genet 1989; 45:681.
  115. Wilkin DJ, Mortier GR, Johnson CL, et al. Correlation of linkage data with phenotype in eight families with Stickler syndrome. Am J Med Genet 1998; 80:121.
  116. Sirko-Osadsa DA, Murray MA, Scott JA, et al. Stickler syndrome without eye involvement is caused by mutations in COL11A2, the gene encoding the alpha2(XI) chain of type XI collagen. J Pediatr 1998; 132:368.
  117. Marcos JC, De Benyacar MA, García-Morteo O, et al. Idiopathic familial chondrocalcinosis due to apatite crystal deposition. Am J Med 1981; 71:557.
  118. Ryan LM, McCarty DJ. Calcium pyrophosphate crystal deposition disease: Pseudogout; articular chondrocalcinosis. In: Arthritis and Allied Conditions, 12th Edition, McCarty DJ, Koopman WJ (Eds), Lea and Febiger, Philadelphia 1993. p.1835.
  119. ZITNAN D, SITAJ S. [Chondrocalcinosis polyarticularis (familiaris): roentgenological and clinical analysis]. Cesk Rentgenol 1960; 14:27.
  120. Baldwin CT, Farrer LA, Adair R, et al. Linkage of early-onset osteoarthritis and chondrocalcinosis to human chromosome 8q. Am J Hum Genet 1995; 56:692.
  121. Hughes AE, McGibbon D, Woodward E, et al. Localisation of a gene for chondrocalcinosis to chromosome 5p. Hum Mol Genet 1995; 4:1225.
  122. Reginato AJ, Passano GM, Neumann G, et al. Familial spondyloepiphyseal dysplasia tarda, brachydactyly, and precocious osteoarthritis associated with an arginine 75-->cysteine mutation in the procollagen type II gene in a kindred of Chiloe Islanders. I. Clinical, radiographic, and pathologic findings. Arthritis Rheum 1994; 37:1078.
  123. ZITNAN D, SIT'AJ S. Chondrocalcinosis articularis Section L Clinical and radiological study. Ann Rheum Dis 1963; 22:142.
  124. Jiminez SA, Williams CJ, Karasick D, et al. Hereditary osteoarthritis. In: Osteoarthritis, Brandt KD, et al (Eds), Oxford University Press, Oxford 1998. p.31.
  125. Matteucci BM. Metabolic and endocrine disease and arthritis. Curr Opin Rheumatol 1995; 7:356.
  126. Bagge E, Edén S, Rosén T, Bengtsson BA. The prevalence of radiographic osteoarthritis is low in elderly patients with growth hormone deficiency. Acta Endocrinol (Copenh) 1993; 129:296.
  127. Mankin HJ, Dorfman H, Lippiello L, Zarins A. Biochemical and metabolic abnormalities in articular cartilage from osteo-arthritic human hips. II. Correlation of morphology with biochemical and metabolic data. J Bone Joint Surg Am 1971; 53:523.
  128. Schumacher HR Jr. Synovial inflammation, crystals, and osteoarthritis. J Rheumatol Suppl 1995; 43:101.
  129. Neogi T, Nevitt M, Niu J, et al. Lack of association between chondrocalcinosis and increased risk of cartilage loss in knees with osteoarthritis: results of two prospective longitudinal magnetic resonance imaging studies. Arthritis Rheum 2006; 54:1822.
  130. McCarthy GM. Calcium crystals and cartilage damage. Curr Opin Rheumatol 1996; 8:255.
  131. Doyle DV. Tissue calcification and inflammation in osteoarthritis. J Pathol 1982; 136:199.
  132. Ali SY, Griffiths S. Formation of calcium phosphate crystals in normal and osteoarthritic cartilage. Ann Rheum Dis 1983; 42 Suppl 1:45.
  133. Boivin G, Lagier R. An ultrastructural study of articular chondrocalcinosis in cases of knee osteoarthritis. Virchows Arch A Pathol Anat Histopathol 1983; 400:13.
  134. Dieppe PA, Crocker PR, Corke CF, et al. Synovial fluid crystals. Q J Med 1979; 48:533.
  135. Gibilisco PA, Schumacher HR Jr, Hollander JL, Soper KA. Synovial fluid crystals in osteoarthritis. Arthritis Rheum 1985; 28:511.
  136. Kalunian KC, Moreland LW, Klashman DJ, et al. Visually-guided irrigation in patients with early knee osteoarthritis: a multicenter randomized, controlled trial. Osteoarthritis Cartilage 2000; 8:412.