Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work.

1. Dr. Mukesh Sah

8. Most common form of arthritis
Result of a failed attempt of chondrocytes to
repair damaged cartilage.
Characteristic of osteoarthritis cartilage
1. ↑ H2O content
2. Alterations in proteoglycans
3. Collagen abnormalities
4. Binding of proteoglycans to

9.  Genetic predisposition
 Can be 1˚ (intrinsic defect) or 2˚ (trauma,
infection, congenital)
 Deterioration and loss of the bearing surface,
followed by osteophyte development and
osteochondral junction breakdown.
 Subchondral cyst, osteophytes, joint space
narrowing
 ↓ Rom and vepitus

10.  Knee commonly affected
 Supportive measures ( activity modification,
cane, brace)
 NSAIDS
 Surgery - arthroscopic debridement
- total joint

11.  Sensory innervations disturbance.
 Causes include diabetes, tabes dorsalis,
syringomyelia, Hanson’s disease,
myclomeningocele, congenital insensitivity to
pain and other neurologic problems (e.g. SCI)
 Older patient with unstable, painless, swollen
joint.
 Advanced destructive changes on both sides of
the joint
 Swelling, warmth, erythema, minimal pain

12.  Variable WBC, ESR
 Technetium bone scan similar (HOT) for
osteomyelitis and charcoats.
 Indium leukocyte scan “hot” (positive) for
osteomyelitis and “colds” (negative) for
charcoats
 Limitation of activity and casting, bracing
 Joint arthroplasty contraindicated

13.  Most common cause of childhood arthritis
 Arthritis and arthralgias from context group A
Beta hemolytic strep infection
 Acute onset of red, tender, painful joint effusions
 Carditis, erythema marginatum, subcutaneous
nudules, chorea, polyarthritis (vones) major
 Migratory arthritis inv., multiple large joints
 Minor: fever, arthralgia, prior RF, elevated ESR,
prolonged PR, ASO
 Penicillin, salicylates

14.  Most common form of inflamatory arthritis
 Affects 3% of women, 1% men
 Morning stiffness, swelling, nodules, pos. lab.
Tests
 Cell mediated immune response (T cell), incites
inflammatory response initially against soft
tissues and later against cartilage
(chondrolysis) and bone (periarticular bone
resorption)

15.  Mononuclear cells the primary cellular
crediator of tissue destruction
 Insidious onset morning stiffness and
polyarthritis
 Hands and feet affected early
 Subcutaneous nodules strongly associated with
positive RF in 20% of RA patient
 Synovium and soft tissues affected first and
later the joints
 Periarticular erosions, osteoperia on X-ray

16.  Pannus in growth denudes articular cartilage
and leads to chondrocyte death
 Elevated ESR, CRP, RF in 80% patient
 Control sinusitis and pain, maintain joint
function and prevent deformities
 Multidisciplinary, drugs, PT, surgery
-synovectomy
-total joint arthroplasty

17.  Immune complex related
 Fever, butterfly malar rash, pancytopenia,
pericarditis, nephritis, polyarthritis
 Joint involvement is the most common feature
affected 75% of SLE patient.
 Arthritis as acute, red, tender swelling of the
PIP, MCP, carpus, knees and other joints
 SLE is typically hot as destructives as RA
 Positive ANA, RF, HLA
 Treatment same as RA

18.  3 major types
Systemic 20%
Polyarticular 50%
Panciarticular 30%
 Seronegative denotes RF- negative
 Seropositive denotes RF- positive
 <15% of JRA is seropositive and associated
with higher incidence of chronic, active and
prog.disease
 Panciarticular denotes ≤ 4 joints are involved
 Early-onset before teens

19.  Late-onset at teenager or later
 Iridiocyclitis in 50% case
 Also be associated with HLA locus
 Text high-close aspirin, gold or remittive
agents
 Ophtha exam
 Involve knee, finger/wrist, ankle, hip and
spine

20.  Bilateral sacroilitis ± acute anterior uveitis in an HLA –
B27 positive is diagnostic
 Insidious inset of back pain associated morning
stiffness and hip pain during third to fourth decade
 Prog. For approx. 20years (prog. Spinal flexion
deformities)
 X-ray: squaring of vertebrae, vertical syndesmophytes,
obliteration of sacroiliac joints
 Ascending ankylosis of spine usually begins in TL
spine
 “chin of chest” deformity
 PT, NSAIDS
 Wedge osteotomy, joint replacement

21.  Hyperuricemia due to nucleic acid do leads to
MSUcrystal deposition in joints
 Crystal activate inflammatory mediators
(proteases, chemotactic factors, prostaglandins,
leukotriene and free oxygen radicals
 Inflammatory mediator rib-by colchime
 Crystals also activate platelets, IL and
complements system
 Phagocytosis rib by phenylbutazone and
indomethacin
 Recurrent arthritis attacks in men 40-60 years old
in lower extremities.

25.  Chr. Granulomatous infection caused by myco
+B invades joints by hematogenous spread
 Spine and LE most often involved
 80% of cases are moviarticular
 Dx. PPD, +AFB in synovial fluid, (+) culture
 X-ray: subchondral osteoporosis, cystic
changes, notch-like bony destruction at the
joint edge, joint space narrowing
 Granulomas with langhans giant cells
 I & D, anti-kocks

27.  Hematogenous spread or by extremities of
osteomyelitis
 Common in children
 Adults pyogenic arthitis common in IV drug
aabusers, sexually active young adults,
diabetics, RA px, trauma or surgery
 Destruction of cartilage can be direct
(proteolytic enzymes) or indirect (pressure and
lack of nutrition)
 I & D, several weeks antibiotics.