etiopathogenesis and clinical features of oa

8/6/2019 Etiopathogenesis and Clinical Features of Oa

http://slidepdf.com/reader/full/etiopathogenesis-and-clinical-features-of-oa 1/31

ETIOPATHOGENESIS AND

CLINICAL FEATURES OF

OSTEOARTHRITIS

DR.S.M. Muhammad Thahir

MBBS., DNB(ORTHO).,



OSTEOARTHRITIS

� Degenerative joint disease or ³wear 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.



�



RISK FACTORS



CLASSIFICATIONS:

�



Pathological Features

Progressive damage of Articular Cartilage.

Subchondral Bone Exposed

Subchondral sclerosis

Subchondral Cyst

Repair of Damage

(Osteophyte)



PRIMARY OSTEOARTHRITIS

� Chronic degenerative disorder related to AGE

� Cartilage matrix has increased water content anddecreased proteoglycan

� This is different from the changes that occur with aging

cartilage dries up.

� Increased activity of proteinases compared to inhibitorsof proteinases.



CELLULAR LEVEL

� Breakdown products of cartilage cause inflammatoryreaction of synovium

� Cytokines cause matrix degeneration. Where do they

come from?� chondrocytes

� Cycle of destruction starts .

� The body goes to work repairing the damage but therepair is inadequate resulting instead in growth of newbone along the side of the existing bone.



� Bony proliferations at joint margins form, what are they

called?

� osteophytes

� Thought to be new bone formation in response to

degenerating cartilage.

� They cause joint motion restriction



Overview of the process

Articular cartilagegets disrupted

Damage progressesdeeper tosubchondral bone.



Left: View of normal elbow cartilage through an

arthroscope - white, glistening, smoothRight: severe elbow osteoarthritis - cartilage is lost

and the bone underneath is exposed



Fragments of cartilagereleased into joint

Matrix degenerates

Eventually there iscomplete loss of cartilage

and complete loss of bone.



commonly affects the hands, feet, spine, and the large weight

bearing joints, such as the hips and knees, although in theory, any joint

in the body can be affected.

�



CLINICAL FEATURES

�� Unlike other systemic forms of arthritis, Osteoarthritis

does not affect the other organs of the body.

� Symptoms vary greatly from patient to patient, but the

most common early symptom is pain in the affected joint

or joints.

� Pain in affected jointsSource:

Without cartilage, bones rub directly against eachother when the joint moves. This is what causes the painand inflammation.



Other sources of Pain

Joint effusion andstretching of the jointcapsule

Torn menisci

Inflammation of periarticular bursae

Periarticular musclespasm

Psychological factors



Pain in the Joint

�

Slow in onset.

Pain may be worse in the morning and feelbetter with activity.

Vigorous activity may cause pain to flareup.

Occurs at rest with advanced disease.

May be referred eg hip pain referred to thethigh, groin, knee.

Pain may be aggravated with weather changes



OTHER SYMPTOMS

� Stiffness , more pronounced in themorning and relieved by bending the Knee.

� Swelling of the Joint.

� Limitation in the motion of the Joint.

� Difficulty in Squatting , Sitting Leg crossedand going stairs



Examination:

� Joint line tenderness.

� Joint line pain can

indicate tear of the lining

of the capsule or themeniscus.

� Bony enlargement of joint

� +/- effusion

� Crepitus

� Decreased range of motion



� In the evaluation of joint line

pain, perform a varus or

valgus stress test.

� Apply stress across the joint,

place fingers directly over the

joint line to assess for pain, a

clunk may indicate a meniscal

tear , or crepitus may indicate

cartilage damage.



� Have the patient liesupine with leg musclesrelaxed

� Compress thesuprapatellar pouch withyour thumb, palm, andindex finger.

� "Milk" downward and

laterally so that anyexcess fluid collects onthe medial side.

� Tap gently over thecollected fluid and

observe the effect on thelateral side

� A fullness on the lateralside indicates thepresence small kneeeffusion



Deformity of the Joint in Advanced cases.

�



�



�

THANK YOU

etiopathogenesis and clinical features of oa

Documents