OA is a chronic arthritic disease characterized by pain, local tissue damage and attempts at tissue repair.

Historically, cartilage damage was believed to be the hallmark of OA. However, since cartilage is an
avascular, aneural tissue, the mechanisms of pain are likely to be complex and influenced by non-
cartilaginous structures in the joint including the synovium, bone and soft tissue. Imaging studies reveal
the presence of synovitis and bone marrow lesions that may mediate pain. The presence of local joint
inflammation and altered cartilage and bone turnover in OA implicates a potential role for a range of
molecular mediators in OA pain. Mechanisms of pain perception may include the activation and release of
local pro-inflammatory mediators such as prostaglandins and cytokines accompanied by the destruction
of tissue, which is mediated by proteases. However, clinically, there is often disparity between the degree
of pain perception and the extent of joint changes in subjects with OA. Such observations have prompted
work to investigate the mechanisms of central pain perception in OA. Functional MRI has identified
multiple areas of the brain that are involved in OA pain processing. These data demonstrate that pain
perception in OA is complex in being influenced by local factors and activation of central pain-processing
pathways. In this review, we will discuss current concepts underlying the pathophysiology of pain
perception in OA and suggest possible directions for the future management of pain in this condition
based on recent clinical studies.
To feel the sensation of pain, our brain must be informed that "it hurts somewhere". This requires that messages from
the nerve endings travel along the nerves that run through to the spinal cord and up to the brain.
However, cartilage is not innervated: it contains no nerve endings. Thus a priori, osteoarthritis, a cartilage disease,
should not be painful ... and yet it is!

Two theories have been advanced to explain the pain of patients with osteoarthritis:

pain comes from the suffering of adjacent tissues that are widely innervated, including the synovial membrane,
the bone located below the cartilage and the ligaments and/or tendons;
pain comes from the cartilage due to the appearance of nerve endings when the cartilage becomes diseased.
The technical term is neo-neuro-genesis (genesis = manufacturing, neuro = nerve, neo = new)
Pengobatan yang dilakukan tergantung pada stadium pengapuran sendi. Pengobatan untuk
pengapuran sendi derajad ringan (yaitu stadium 1 dan 2) terdiri atas :

Menurunkan berat badan bagi yang kelebihan berat badan,

Latihan untuk menguatkan otot paha dan pinggul serta untuk menjaga kebugaran tubuh,
seperti berenang dan naik sepeda,
Obat anti-radang dan anti-nyeri,
Suplemen yang mengandung glukosamin untuk menumbuhkan tulang rawan,
Obat pelumas sendi yang mengandung asam hialuronat dan yang perlu disuntikkan ke dalam
sendi. Orang awam sering menyebut obat yang terakhir tersebut sebagai penambah oli
sendi.

Suntikan obat pelumas sendi hanya bermanfaat untuk pengapuran sendi ringan (stadium 1 dan 2).
Sedangkan untuk pengapuran sendi berat (stadium 3 dan 4) obat tersebut bisa meredakan namun
durasinya lebih pendek dalam mengurangi rasa nyeri, karena tulang rawan sendi pada umumnya tidak
hanya menipis, tetapi telah hilang sama sekali sehingga tidak ada lagi tulang rawan yang tersisa
untuk dilumasi lagi.

Cukup banyak pasien yang kecewa telah mendapat suntikan obat pelumas sendi, tetapi tidak sembuh.
Banyak diantaranya mendapat suntikan 5 sampai 10 kali pada kedua lututnya, tetapi tetap terasa
nyeri. Hal ini disebabkan karena mereka telah mengalami pengapuran sendi stadium 3 atau 4
sehingga obat pelumas sendi kurang bermanfaat.

Oleh karena itu, bentuk pengobatan non-operasi tersebut di atas biasanya hanya bermanfaat untuk
pengapuran sendi ringan dan menengah (stadium 1 dan 2, 3) dan tidak memberikan hasil yang
memuaskan untuk derajad yang berat. Untuk pengapuran sendi berat (yaitu, stadium 4), pilihan
pengobatan terbaik yang tersedia adalah operasi penggantian sendi.

Suplemen sendi : Glukosamin dan Chondroitin , masing-masing memiliki fungsi yaitu : Chondroitin sulfat
berguna untuk merangang pertumbuhan tulang rawan dan menghambat perusakan tulang
rawan.Glukosamin adalah pembentukan proteoglycan, bekerja dengan merangsang pembentukan tulang
rawan, serta menghambat perusakan tulang rawan