osteoarthritis
DESCRIPTION
OsteoarthritisTRANSCRIPT
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Chronic disorder Degenerative joint disease result in progressive erosion
of articular cartilage
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Epidemiology
Starts at 50 years of age Female > male (2: 1) 10% of general population
*OA increases in frequency with age. Not because of ageing but OA takes many years to develop.
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Classification
Primary OA – idiopathic and appear insidiously arises without obvious predisposing
influences ( majority of cases) Oligo-articular
AgeGenetic – familial tendency
Obesity – OA knee
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Secondary OA – presence of other predisposing factor Previous trauma and mechanical problem –
intrarticular # (stepping >1cm),recurrent dislocation
Infection – septic arthritis Congenital deformity of a joint- Perthe’s ds,
SUFE Inflammatory – RA Underlying systemic diseases
DM, Haemochromatosis, Obesity Knees & hands in women, Hips in men
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Pathology
The cardinal features are: Progressive loss of cartilage thickness Subarticular cyst formation and sclerosis Remodelling of the bone ends and
osteophyte formation Synovial irritation Capsular fibrosis
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Pathogenesis
the normal homeostasis in the joint is disturbed
OA is a disease of wear-&-tear based on: Occur in old age Weight bearing joints Increase frequency in the joints predisposed to
abnormal mechanical stress obese & previous joint deformity
Genetic factors Risk increased with:
Reduced Bone density High levels of oestrogen
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Characterized by significant changes of: Composition Mechanical properties of cartilage
Early the degenerating cartilage Increased in water Decreased concentration of proteoglycans Weakening of collagen network (reduce type II
collagen) IL-1, TNF and NO are increased in the joint Increased apoptosis of chondrocytes
These resulted in: Reduce tensile strength Reduce resilience DEGENERATION
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Morphology Early stage:
Increased in chondrocytes
Subsequently cracking of the matrix
Gross Granular surface Small fractures &
dislodge , producing ‘joint mice’
Osteophytes formation
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Clinical features
Pain Stiffness Swelling Deformities Joint instability Loss of function
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History
Age – 50++, obese? Occupation – what type? Any history of trauma that involve joint? Rule out secondary causes – cong, RA Any joint pain? – become worst by activity, relieve by rest(usually patient complaint cannot walk long distance, stand
for long) Joint stiffness – early morning, long rest Noticed swelling? Ask daily activity affected or not??- Climbing stairs- How do they pray?- House works – cooking, laundry
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Physical examination
1. General examination Elderly, obese lady2. Inspection• Antalgic gait• Varus deformity• Muscle wasting over the quadriceps• Joint is swollen• No redness or discoloured 3. Palpation Min/no joint effusion (patella tap) Check for tenderness Synovial membrane not thickened Protuberant (osteophyte) at the edge of articular cartilage
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4. Movement Limited (reduced ROM) Crepitus on movement5. Special test Valgus and varus stress test
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Clinical course
Insidious onset Deep, achy pain that
worsen with use Morning stiffness Crepitus Limited ROM Impingement on
spinal foramina by osteophytes radicular pain, muscle spasm & atrophy
Typically, only one or a few joints
Joint involved: Hips Knees Lower lumbar & cervical Proximal & distal IP
joints First carpometacarpal First metatarsal
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Heberden nodes: In women, not in
men Prominent
osteophytes at the distal IP joints
No satisfactory means of preventing primary OA
Permanent disability
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Investigation
X – ray features: Narrowing or loss of joint space (1st sign of OA)
reflects loss of articular cartilage; main pathology Osteophyte formation-around the periphery of
the joint Subchondral sclerosis-looks very white on the
radiograph Subchondral cyst
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Treatment of osteoarthritis can be divided into 2: Conservative management Operative management
indicated for patients with persistent symptoms
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TREATMENTTry to treat patient conservatively, if failed-surgical
1. CONSERVATIV
E
Relieve pain– Analgesic and
NSAIDS- Intra articular corticosteroid- Rest period
and modification of
activity
To increase movement to
prevent ms wasting and
deformity/contracture-
physiotherapy/exercise
programme,non -weight bearing
exercise to strengthen ms
strength (cycling.swimming)
To reduce load on the joint
-Weight loss if patient is obese- Use of walking
stick to distribute the load- avoid
unnecessary stress,eg
jogging,climbing stairs
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2.OPERATIVE MANAGEMENT
Arthroscopic debridement and
cleaning of the joint cavity and infusion
of synthetic synovial fluid
Realignment osteotomy- for
unicompartmental OA, to redistribute
the loading forcetowards less damaged parts of
the jt
Arthrodesis-If stiffness is
acceptable and neighbouring joints are not likely to be
prejudiced- Usually done in
young patient
Arthroplasty-Joint replacement- Usually done in
old patient