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