osteoarthritis
TRANSCRIPT
Dr M. NadeemAssistant Prof Medicine
Islamabad Medical and Dental college
Osteoarthritis is a non-inflammatory, degenerative condition of joints Characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes
Internationally, osteoarthritis is the most common articular disease
Estimates of its frequency vary across different populations
Primary osteoarthritis is a common disorder of the elderly
Approximately 80-90% of individuals older than 65 years have evidence of radiographic primary osteoarthritis
prevalence of the disease increases dramatically among persons older than 50 years
In individuals older than 55 years, the prevalence of osteoarthritis is higher among women than among men
Osteoarthritis is more common in whites than in blacks
In early osteoarthritis, swelling of the cartilage usually occurs
Over time, the loss of cartilage results in loss of joint space
Bone denuded of its protective cartilage The subchondral bone responds with vascular
invasion and increased cellularity, becoming thickened and dense
At areas along the articular margin there is irregular outgrowth of new bone (osteophytes)
Along with joint damage, osteoarthritis may also lead to pathophysiologic changes in associated ligaments and the neuromuscular apparatus
Although osteoarthritis has been classified as a noninflammatory arthritis
Increasing evidence has shown that inflammation occurs as cytokines and metalloproteinases are released into the joint
Right: Early OA with area of cartilage loss in the center.
Left: More advanced changes with extensive cartilage loss and exposed underlying bone
Age Female versus male sex Obesity Lack of osteoporosis Occupation Sports activities Previous injury Muscle weakness Proprioceptive deficits Genetic elements Acromegaly Calcium crystal deposition disease
OA
Primary OA Secondary OA
More common than secondary OA Cause –Unknown Common-in elders where there is no previous
pathology. Its mainly due to wear and tear changes
occuring in old ages mainly in weight bearing joints.
Due to a predisposing cause such as:1.Injury to the joint2.Previous infection3.RA5.Deformity6.Obesity7.hyperthyriodism
The progression of osteoarthritis is characteristically slow, occurring over several years or decades
Joint pain in weight bearing joints like knee, spine and hip
Deep, achy joint pain exacerbated by extensive use
reduced range of motion and crepitus are frequently present
Stiffness during rest (gelling) may develop, with morning joint stiffness usually lasting for less than 30 minutes
Initially, pain can be relieved by rest and may respond to simple analgesics
However, joints may become unstable as the osteoarthritis progresses
Physical examination findings in patients with osteoarthritis are mostly limited to the affected joints
Reduced range of motion and crepitus Most cases of osteoarthritis do not involve
erythema or warmth over the affected joint(s) Effusion may be present Muscle atrophy around a more severely
affected joint may occur
Heberden nodes, which represent palpable osteophytes in the DIP joints
Bouchard's nodes at proximal interphalangeal joints
Nodal osteoarthritis Note bony enlargement of distal and proximal interphalangeal joints (Heberden's nodes and Bouchard's nodes, respectively).
Rheumatoid ArthritisRheumatoid Arthritis GoutGout CPPD (Calcium pyrophosphate crystal CPPD (Calcium pyrophosphate crystal
deposition disease)deposition disease) Septic JointSeptic Joint Polymyalgia Rheumatica Polymyalgia Rheumatica
OA is diagnosed on the basis of clinical findings and radiographic changes
Now specific lab investigations
Joint space narrowingJoint space narrowing Subchondral sclerosisSubchondral sclerosis Marginal osteophytesMarginal osteophytes Subchondral cystSubchondral cyst
Asymmetrical joint space narrowing from loss of articular cartilage
The medial (inside) part of the knee is most commonly affected by osteoarthritis.
OA – Radiographic Diagnosis
OA – Radiographic Diagnosis•Asymmetrical joint space narrowing
•Periarticular sclerosis
•Osteophytes
•Sub-chrondral bone cysts
OA typically asymmetricalOA typically asymmetrical
Paget’s disease
OA – Arthroscopic Diagnosis
Arthroscopy allows earlier diagnosis by demonstrating the more subtle cartilage changes that are not visible on x-ray
Severe, acute joint pain is an Severe, acute joint pain is an uncommon manifestation of OA uncommon manifestation of OA
Clear fluid WBC <2000/mm3Clear fluid WBC <2000/mm3
Normal viscosityNormal viscosity
Weight LossWeight Loss Ten-pound weight loss over 10 years decreased the Ten-pound weight loss over 10 years decreased the
odds for developing knee OA by 50%odds for developing knee OA by 50% Even a modest amount of weight loss may be Even a modest amount of weight loss may be
beneficialbeneficial RestRest
Short period of time, typically 12-24 hours Short period of time, typically 12-24 hours Prolonged rest can lead to muscle atrophy and Prolonged rest can lead to muscle atrophy and
decreased joint mobilitydecreased joint mobility
Patient education Heat and cold Exercise Physical therapy Occupational therapy
Topical capsaicin Topical nonsteroidal anti-inflammatory drugs
(NSAIDs) - Including trolamine salicylate Oral NSAIDs Tramadol Intra-articular corticosteroid injections Glucosamine and chondroitin sulfate have
been used in Europe for many years and continue to be popular with patients worldwide
A referral to an orthopedic surgeon may be necessary if the osteoarthritis fails to respond to a medical management plan
Arthroscopy Osteotomy Arthroplasty - Particularly with knee or hip
osteoarthritis Fusion