Osteoarthritis risk factors

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Osteoarthritis risk factors

  1. 1. andpresentOsteoarthritis risk factorsOsteoarthritis risk factors
  2. 2. "Osteoarthritis, why me?" You have told your patient that he/she has osteoarthritis.He/she is asking both you and him/herself "Why me?". The main risk factor is age: Osteoarthritis affects only 3% of peopleaged less than 45 But it affects 65% of people aged over 65.This doesnt mean that all these are actuallyin pain, because osteoarthritis can be clinicallysilent 80% of people in the over 80 age grouphave osteoarthritis Although age is the primary risk factor,there are many others of varying importance2Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.aspInserm (National medical research institute) websitehttp://www.inserm.fr/thematiques/circulation-metabolisme-nutrition/dossiers-d-information/arthrose
  3. 3. The hips and knees are not the mostcommonly affected jointsThe spine and fingers are the most commonlyaffected jointsIt is most severe and debilitating when itaffects the knees and hips, both of whichare weight-bearing jointsWhile more uncommon, shoulderosteoarthritis is also very debilitatingThe ankles and elbows can be affected butthis is less common and tends to occur after jointand/or bone injury3Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.asp
  4. 4. 4Flexor tenosynovitis in zone IV. MRI of both hands via the MCP, gadolinium-enhancedTI-weighted sequences and fat signal saturation in axial slices (prayer position).Synovitis: synovial membrane enhancement.Internal and external femorotibialosteoarthritis. Knee CT-arthrography.Hip-femoral osteoarthritis. Right hip arthrography,frontal image.Cervical spine. T2 MRI.
  5. 5. Risk factors for osteoarthritisMain risk factors Age Excess weight and obesity Mechanical constraints (intensesport, some professions) Heredity Female gender, menopause Osteonecrosis Leg bone malalignement Estrogen deficiency Metabolic syndrome Advanced hip osteoarthritis causedby spondylarthritis or rheumatoidarthritis5Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A1_pourquoi.aspNational health insurance website:http://www.ameli-sante.fr/arthrose-de-la-hanche/facteurs-de-risques-arthrose-de-la-hanche.htmlhttp://www.ameli-sante.fr/arthrose-du-genou/facteurs-de-risque-arthrose-du-genou.htmlINSERM (National medical research institute) websitehttp://www.inserm.fr/thematiques/circulation-metabolisme-nutrition/dossiers-d-information/arthroseOther risk factors Injury: cruciate ligament rupture,meniscectomy (surgical removal ofmeniscus) Metabolic diseases (chondro-calcinosis, genetic hemochromatosis) Infectious diseases involving the bone Rheumatoid arthritis sequellae
  6. 6. Weight and osteoarthritis: a complicatedrelationshipIn overweight patients and especially in the obese, the jointsare exposed to mechanical constraints which tend topromote the development of osteoarthritis, particularly in thekneesHowever: Obesity has a "dose-related" effect: the risk of knee osteoarthritisincreases by 15% for every point increase in the BMI. The risk ofknee osteoarthritis therefore increases with weight It is important to note that finger joint osteoarthritis is morecommon in obese patients!6 Body Mass Index calculation (BMI) Overweight if BMI = 25-29.9 kg/m2 Obesity > 30 kg/m2 Morbid obesity > 40 kg/m2Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A1_pourquoi.aspSellam J, Berenbaum F. Arthrose et obésité. Rev Prat 2012;;62::621-624.
  7. 7. When mechanical constraint promotesosteoarthritisMechanical constraint is a risk factor for osteoarthritis,particularly in the kneeThe knee is a complex joint and weight must be evenlydistributed and not excessive. The risk factors for kneeosteoarthritis are therefore:7 Being overweight or, especially, obese leg bone malalignement (genu varum [bow legs] and genu valgum[knock-knees]) Knee instability caused by ligament rupture (cruciate ligaments) Surgical removal of a meniscus (meniscectomy) Repeatedly carrying excessive loadsINSERM (National medical research institute) websitehttp://www.inserm.fr/thematiques/circulation-metabolisme-nutrition/dossiers-d-information/arthroseOther risk factors for osteoarthritis include an untreatedsprain or a joint fracture
  8. 8. Knee osteoarthritis, injury and surgery There are two forms of injury which play a particularlyimportant role in the onset of knee osteoarthritis : Sprain with ligament tear, creating knee instability, Meniscus damage8 Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.asp Cruciate ligament surgery will not totally prevent the riskof osteoarthritis after these types of injury: Experience shows that while surgery reduces this risk,it nonetheless remains high Conversely, meniscus removal is a major risk factorfor osteoarthritis: Studies have reported that 5 to 10 years after meniscectomy, theincidence of osteoarthritis was much higher in the operated knee(21% versus 5% on the non-operated side). Furthermore,meniscectomy is an excellent model of induced osteoarthritis inanimalsPatellofemoral knee osteoarthritis.
  9. 9. Physical exercise and osteoarthritis When not practiced to excess, physical exerciseis not a risk factor for osteoarthritis The risk factors are considered to be: Top-level sports with the risk of injury: footballand rugby for the knees Repetitive excessive load-bearing Repeated microtrauma (workers regularly usinga jack hammer: elbow osteoarthritis) Some professions placing excessive pressure onthe knees (tiler, carpet-fitter, mason, painter anddecorator, gardener, etc.)9Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.asp
  10. 10. Heredity and osteoarthritis People with a parent or sibling who has osteoarthritisare at higher risk of developing the disorder The proof: there are families in which the proportion of adultsaged over 50 with osteoarthritis is much higher thanin the general population concordance of osteoarthritis is more commonin identical than non-identical twins however, these genetic factors have been demonstratedmainly for hip or hand osteoarthritis.10Société Française de rhumatologie website:http://www.rhumatologie.asso.fr/04-Rhumatismes/grandes-maladies/0B-dossier-arthrose/A0_definition.aspINSERM (National medical research institute) websitehttp://www.inserm.fr/thematiques/circulation-metabolisme-nutrition/dossiers-d-information/arthrose
  11. 11. 11MRI of both hands and wrists: SE T1 sagittal images.Hip osteoarthritis surrounding the hip.
  12. 12. Other risk factors Gender and hormonal status: post-menopausal womenare at higher risk of hip, knee or hand osteoarthritis thanmen of a similar age Differences in long bone length increase the risk of hiposteoarthritis but it may also affects subjects aged lessthan 5012http://www.ameli-sante.fr/arthrose-de-la-hanche/facteurs-de-risques-arthrose-de-la-hanche.htmlhttp://www.ameli-sante.fr/arthrose-du-genou/facteurs-de-risque-arthrose-du-genou.html
  13. 13. ConclusionOsteoarthritis is a strongly age-associated conditionThe most commonly affected joints are the spine(back bone) and handsOsteoarthritis is most debilitating when it affects thehip or kneeOverweight patients are at higher the risk ofdeveloping osteoarthritis, particularly in the kneesNormal physical exercise is not a risk factor (if noinjuries are sustained)Post-menopausal women are at higher risk of hip orknee osteoarthritis than men of a similar ageAn unstable knee and leg malalignement are riskfactors for the development of knee osteoarthritis13
  14. 14. 14Lumbar canal stenosis,posterior lumbar facet jointosteoarthritis, sagittal imageof lumbar spine.Hand and wrist MRI: coronalimage, SE T1 sequence withsuppression of fat signal andinjection of gadolinium.Primary osteoarthritis,CT-arthrography.Advanced internalfemorotibial kneeosteoarthritis. MRI T2 images.

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