Rethinking Osteoarthritis — More Than Just “Wear and Tear”.
- Sherry Routledge
- Oct 26
- 4 min read
For years, osteoarthritis (OA) has been explained as nothing more than wear and tear on the joints, but that story is incomplete. Research now shows OA is far more complex. It isn’t just cartilage thinning with age or overuse. It’s a whole-joint condition, shaped by the immune system, inflammation, and biomechanics.
Let’s take a closer look at what’s happening inside an osteoarthritic joint and why this matters for us as therapists.
Low-Grade Inflammation — the Silent Driver
OA is best understood as a low-grade inflammatory condition. The joint lining, called the synovium, often becomes inflamed. This process, called synovitis, is not the same aggressive autoimmune reaction seen in rheumatoid arthritis. Instead, it is a quieter, chronic irritation that still does plenty of harm.
Chemical messengers released by the immune system break down cartilage and drive joint damage. Much of this activity comes from macrophages. These are immune cells designed to clean up and repair, yet in OA they often stay locked in a destructive role.
