Osteoarthritis: OA
Janet Pope MD MPH FRCPC
Goals
• Identify the most common joints affected in OA
• Differentiate OA from RA• Describe the most common treatments for
OA including non-pharmological
Case: Diane
• This is a 62 year old woman with 3 kids• She has had on-going bilateral knee pain
for the past 3 years• It flares on and off• It tends to be worse when she is active• At times she has difficulty sleeping
because of knee pain
Diane has made some positive moves
• She manages to walk every morning when her knees are “feeling good”
• She lost 28 lbs and has kept it off for the last 5 years
• She is otherwise healthy and takes no other medications with the exception of occasional acetaminophen for her knees
OA Knee Xrays
• Often we order weight bearing views• AP knees standing• Joint space narrowing• Osteophytes, sclerosis, bony cysts• Joint space narrowing may be
assymetrical• Malalignment (ex valgus or varus
deformity)
Here are Diane’s Hands
Diagnosis
• Diane has osteoarthritis – OA / degenerative arthritis
• Osteoarthritis is the most common form of chronic arthritis
Osteoarthritis: Definition
• A joint disease characterized by:– Pain that typically worsens with weight
bearing and activity and improves with rest– Morning stiffness and gelling of the involved
joint after periods of inactivity– Tenderness on palpation, bony enlargement,
crepitus on motion, and/or limitation of joint motion
– There may be joint swelling and heat
ACR Recommendations: Arthritis Rheum 2000; 43(9):1905-15.
Osteoarthritis Facts
• OA affects 3,000,000 (1 in 10) Canadians1
• OA is associated with significant costs:2
– Direct (e.g., drugs, healthcare resource use)– Indirect (e.g., lost employment time, costs of
informal caregiving)• Under treatment leads to significant pain
and loss of quality of life
1 & 2 - Arthritis Society of Canada: www.arthritis.ca
Osteoarthritis: Clinical Characteristics
• OA is common• It is not always symptomatic• Usually insidious onset• Usually less than a half hour of am joint
stiffness• Younger age Men>women• Older age Women>men• Worse with activity• Better with rest
Bony Enlargement
DIP bony enlargementHeberden’s nodes
PIP bony enlargementBouchard’s nodes
Distribution of Joints• Hands:
– DIP, PIP, 1st CMC joints• Hip• Knee• Feet:
– First MTP• Spine
– Cervical, lumbar
OARA
First CMC OA –squaring at base of thumb