Osteoarthritis

Items:

.Definition.

.Classification.

.Risk factors.

.Path physiology.

.Symptoms and signs.

.Diagnosis.

.Treatment .

Definition:Osteoarthritis (OA), which is also known as osteoarthrosis or degenerative joint disease (DJD):

is a progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints.

Classification:

1.primary: unkown cause, with aging, on normal joint.

2.secondary: other disease(trauma, hemochromatosis, D.M, RA, congenital), any age, on diseased joint.

Risk Factors

Age

Female

Obesity

malalignment

Repetitive knee bending

High impact activities

Muscle weakness

Other diseases : RA

Path physiologyOA is primarily disease of cartilage.

Il-1 is a potent pro-inflammatory cytokine, which capable of inducing chondrocytes and synovial cells to synthesize MMPs.

MMPs is responsible of degradation of articular cartilage.

In addition, IL-1 inhibits synthesis of collagen II, proteoglycans and growth factor B stimulated chondrocyte proliferation

Symptoms and signs: Pain increases with

activity and worse at night.

Stiffness less than 30 mins.

Swelling

Deformities

Joint instability

Loss of function

Neurological signs if spine Involved.

Crepitus

Muscle wasting

DiagnosisNo special test for diagnosis.

Clinically: History and Examination.

Lab investigations.

HistoryAge - > 50 years BMI?Occupation – what type ?

Any history of trauma around the joint?

Secondary causes – congenital, RAAny joint pain become worst by activity, relieved by rest.

Joint stiffness – early morning, long rest

Swelling?Affect on daily activity!!

Climbing stairs

ExaminationGeneral examinationInspectionGait (antalgic!)Deformity(varus/valgus)Muscle wasting (quadricep)Joint swellingerythemaPalpationJoint effusionTendernessPalpableosteophytes

Movement

Crepitus

Reduced/limited ROM

Investigation:

1 .Arthrocentsesis:Synovial fluidWBC<1000/mm3

Clear colorHigh Viscosity

2 .X-ray:

Treatment:1 .Non-pharmacological:

To increase movement to prevent muscle wasting and deformity/contracture.

physiotherapy/exercise programme,

non -weight bearing exercise to strengthen muscle strength (cycling, swimming etc).

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.

2 .pharmacological:

Pain relief

Analgesic and NSAIDS

Intra-articular corticosteroid.

3 .surgery.

Examples Group of drug

Acetaminophen and tramadol

Analgesics

Aspirin, ibuprofen and naproxen

NSAID

celecoxib Cox-2 inhibitors

Cream or spray as zostrix Topical analgesics

Injectable glucocorticoid Corticosteroid

Hyaluronic acid viscosupplements

Glucosamine and Chondrotin Sulfate

Bone components

degradative Enz Growth Future therapy

Management:Lifestyle Modifications Acetaminophen PRN

NSAIDs PRN

Opioids PRN

Celecoxib

Steroid Injections

Hyaluronan Injections

Surgical Referral

Surgery:ArthroscopyMainly for knee and shoulder.

Remove of loose pieces of bone or cartilage and treatment of torn ligament or inflamed synovial membrane

OsteotomyMainly for knee and hip.

For people younger to do joint replacement.

Repositioning of bone by a wedge shape cut.

Joint ReplacementFor people over 50y or severe progression

Reconstruction of a joint