骨关节炎(OA)是一种退行性关节疾病,女性比男性更普遍,尤其是在以后的生活中。这表明该疾病的发病机理中可能存在性二态性。这篇综述的目的是讨论膝关节OA发育和表现中性二态性的证据,因为它是由两个相反的范式构成的:生物力学和生物学。
■对数据库进行了全面搜索,包括:但不限于,MEDLINE通过Ovid,PubMed,谷歌学者。关键词包括骨关节炎,性别差异,和/或性二态性结合膝关节生物力学进行搜索,ACL,关节错位,雌激素,软骨细胞信号(l)ing,生长因子和整合素。
■生物力学方法已经确定了关节错位的性别差异,骨骼形状,步态,和下肢肌肉力量导致改变的负荷传递,以及增加的女性膝关节松弛诱发关节损伤。生物学方法主要集中在雌激素受体信号传导对关节组织维持的影响上。除了更全身水平的炎性细胞因子和代谢物外,还报道了在涉及生长因子和胶原蛋白受体的软骨细胞信号通路中鉴定性二态性的初步工作。
■了解OA的真正病因对于开发有效,个性化医疗时代的个体化治疗。从“一刀切”的心态向个性化治疗方法的转变必须从承认OA发生和发展的生物力学和生物学因素的性别差异开始。
UNASSIGNED: Osteoarthritis (OA) is a degenerative joint disease that is more prevalent in women than men, especially later in life. This suggests that sexual dimorphism may be present in the pathogenesis of the disease. The purpose of this review is to discuss evidence of sexual dimorphism in knee OA development and presentation as it is framed by two contrasting paradigms: biomechanics and biology.
UNASSIGNED: A comprehensive search of databases was conducted including, but not limited to, MEDLINE via Ovid, PubMed, and Google Scholar. Keywords including osteoarthritis, sex differences, and/or sexual dimorphism were searched in combination with knee biomechanics, ACL, joint malalignment, estrogen, chondrocyte signal(l)ing, growth factor and integrin(s).
UNASSIGNED: The biomechanical approach has identified sex differences in joint malalignment, bone shape, gait, and lower limb muscle strength leading to altered load transmission, as well as increased knee laxity in women predisposing them to joint injury. The biological approach has largely focused on the influence of estrogen receptor signaling on the maintenance of joint tissues. Preliminary work identifying sexual dimorphism in chondrocyte signaling pathways involving growth factors and collagen receptors has been reported in addition to more systemic levels of inflammatory cytokines and metabolites.
UNASSIGNED: Understanding the true etiology of OA is crucial for developing effective, individualized treatment in the age of personalised medicine. A shift from a \'one size fits all\' mentality towards an individualized approach for therapeutic treatment must begin with the acknowledgment of sex differences in the biomechanical and biological factors underlying the onset and development of OA.