Damage to cartilage and neighboring tissues (capsule, tendons, ligaments and bone) occurs by 2 mechanisms: development of granulation tissue together with proliferation of synovial cells with direct destruction of the articular cartilage as well as release of lysosomal enzymes from synoviocytes, polymorphonuclear cells and macrophages, as acidic and neutral proteases, collagenases and proteolytic enzymes capable of fragmenting proteoglycans and collagen fibers.
Prostaglandin PGE2, synthesized by the affected synovium, has an important role in bone resorption, as well as synovial fluid enzymes. In the third phase (fibrosis and ankylosis) Flekosteel, deformation and joint immobility occur.
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