By By

Blossom SamBlossom Sam

22ndnd yr BSc Physician Assistant yr BSc Physician Assistant

Global college of AHSGlobal college of AHS

ChennaiChennai

OsteoarthritisOsteoarthritis

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DefinitionDefinition Also known as

degenerative joint disease or “wear and tear arthritis”.

Progressive loss of cartilage with remodeling of subchondral bone and progressive deformity of the joint.

Cartilage destruction may be a result of a variety of etiologies

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EpidemiologyEpidemiology

The prevalence increases with age( mostly above 60 years)

Under 45 yrs it is equally common in men and women Over 55 yrs its more common in women than men It is not an inevitable part of aging, some people are more

susceptible than others A combination of different factors are involved. Both mechanical and biologic destructive processes play

a role in OA.

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CausesCauses

Aging Heredity Obesity Joint injuries Joint over use Playing sports

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Medical conditions that can lead to OA include:

1. Bleeding disorders that cause bleeding in the joint, such as hemophilia

2. Disorders that block the blood supply near a joint and lead to avascular necrosis

3. Other types of arthritis, such as chronic gout, pseudogout, or rheumatoid arthritis

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ClassificationClassificationPrimary Idiopathic Localized or generalized Local: knee, hip, spine,

hands Generalized: large joints

and spine Small peripheral joints

and spine Mixed and spine

Secondary Post-traumataic Congenital or

developmental Localized or generalized Calcium deposition

disease Other: Inflammatory Avascular necrosis

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Inflammatory OAInflammatory OA

OA is generally a non-inflammtory arthritis. Increasing evidence for inflammatory type: caused by

cytokines, metalloproteinase release. This erosive inflammatory type may have flares but later

acts like typical OA. Primarily in women May be suspected from evidence of active synovitis,

chondrocalcinosis on x-rays, morning stiffness greater than 30 mins, history of swelling and night pain.

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Signs and symptomsSigns and symptoms

Pain and stiffness of the joint A physical exam can show:1. Joint movement may cause a cracking (grating) sound,

called crepitation2. Joint swelling (bones around the joints may feel larger

than normal)3. Limited range of motion4. Tenderness when the joint is pressed5. Normal movement is often painful

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Overview of the processOverview of the process

Articular cartilage gets disrupted

Damage progresses deeper to subchondral bone

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Fragments of cartilage released into joint

Matrix degenerates Eventually there is

complete loss of cartilage Bone is exposed

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InvestigationInvestigation

No single test can diagnose osteoarthritis.

• Medical history

• Physical exam

• X rays

• Other tests such as blood tests or exams of the fluid in the joints.

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left: Normal x-ray Right: worn away cartilage reflected by decreased joint

space

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X-ray featuresX-ray features Radiographic changes visible relatively late in the

disease Subchondral sclerosis Joint space narrowing especially where there is stress Subchondral cysts Osteophytes Bone mineralization should be normal

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Joint space narrowing where there is more stress

Subchondral bone has thickened

bony overgrowth

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Clinical features and diagnosisClinical features and diagnosis Pain Sources

Joint effusion and stretching of the joint capsule Torn menisci Inflammation of periarticular bursae Periarticular muscle spasm Psychological factors

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Characteristics Deep, aching localized to the joint Slow in onset Worsened with activity in initial stages Occurs at rest with advanced disease May be referred

eg. hip pain referred to the thigh, groin, knee. Pain may be aggravated with weather changes

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ExaminationExamination

Joint line tenderness Bony enlargement of joint +/- effusion Crepitus Decreased range of

motion

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Involved jointsInvolved joints DIP, PIP 1st carpometacarpal cervical/lumbar facet

joints 1st metatarsophalangeal Hips Knees

Uncommon Wrist, elbows, shoulders,

ankles

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1st metatarso-phalangeal most commonly affected in OA of the foot.

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Typical findingsTypical findings

Heberden’s nodes

Bouchard’s nodes

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Rt: varus deformity of the knee

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Osteoarthritis treatment plans can involve:

• Improve joint function • Keep a healthy body weight • Control pain • Achieve a healthy lifestyle. • Exercise • Medicines • Complementary and alternative therapies • Rest and joint care • Surgery.

TreatmentTreatment

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MedicationsMedications

Non-pharmacokinetic No proven medication-based disease modifying

intervention exists. Analgesics (acetominophen) NSAIDS Help pain symptoms but controversial for long term use

in non-inflammatory OA because of risks vs benefits Narcotics Intra-articular steroids Chondroprotective agents Anti-depressants

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Side effectsSide effects Rash/hypersensitivity GI bleeding CNS dysfunction in elderly Impairment of renal/hepatic/platelet function. By interfering with vasodilator renal PG and causing

renal ischemia.

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Surgical: Surgical:

Arthroscopy

arthroscopy is not recommended for nonspecific "cleaning of the knee“.

Used to fix specific structural damage on imaging (repairing meniscal tears, removing fragments of torn menisci that are producing symptoms).

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Joint replacement

If all other rx ineffective, and pain is severe

Loss of joint function

Joints last 8-15 years without complications

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PrognosisPrognosis

Every person with OA is different. Pain and stiffness may prevent one person from performing simple daily activities, while others are able to maintain an active lifestyle that includes sports and other activities. The patient’s movement may become very limited over time.

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PreventionPrevention

Try not to overuse a painful joint at work or during activities.

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QUESTIONS

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