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4 Osteo Arthritis 2010

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pathophysiology

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4 Osteo Arthritis 2010

  1. 1. Osteoarthritis
  2. 2. Objectives  Compare & contrast the sequence of events leading to joint destruction in osteo-arthritis & rheumatoid arthritis  Describe the clinical manifestations of OA and RA
  3. 3. Osteoarthritis  Most common form of joint disease in NZ  Non-inflammatory disorder of the synovial joints  Slowly progressive  More than 90% of adults are affected by age 40
  4. 4. Osteoarthritis  Before age 50, men are more often affected than women  Incidence of OA after 50 is twice as great in women
  5. 5. Etiology and Pathophysiology Cause can be unknown or a known event or condition that directly damages cartilage or causes joint instability e.g.. trauma, repetitive physical activities, congenital dislocation of the hip
  6. 6. Etiology and Pathophysiology  Estrogen reduction at menopause  Genetic factors  Obesity  Strenuous exercise activities
  7. 7. Etiology and Pathophysiology  Results from cartilage damage  Causes the normally smooth, white, translucent articular cartilage to become dull, yellow & granular  Affected cartilage: – Dull, yellow, granular – Softer, less elastic – Less able to resist wear
  8. 8. Etiology and Pathophysiology  Body’s attempts at repair cannot keep up with destruction  Continued changes in collagen structure  fissuring and erosion
  9. 9. Etiology and Pathophysiology  Central cartilage becomes thinner  Cartilage and bony growth (osteophytes) increase at the joint margins  Secondary synovitis – Inflammatory changes  early pain and stiffness
  10. 10. Pathophysiology of osteoarthritis
  11. 11. Clinical Manifestations  No systemic manifestations  Joint pain – Predominant symptom – Relieved by rest in early stages
  12. 12. Clinical Manifestations  Joint pain – Generally worsens with joint use – May become worse as barometric pressures fall before inclement weather
  13. 13. Clinical Manifestations  Joint pain – May be referred to: • Groin • Buttock • Medial side of thigh or knee
  14. 14. Clinical Manifestations  Joint pain – Crepitation • Grating sensation caused by loose particles of cartilage in the joint cavity
  15. 15. Clinical Manifestations  Joint pain – Affects joints asymmetrically – Early morning stiffness • Resolves within 30 minutes
  16. 16. Clinical Manifestations  Most commonly involved joints: – Distal interphalangeal (DIP) – Proximal interphalangeal (PIP) – Carpometacarpal joint of the thumb – Weight-bearing joints (hips, knees) – Metatarsophalangeal (MTP) – Cervical and lower lumbar vertebrae
  17. 17. Joints Involved in Osteoarthritis Fig. 63-2
  18. 18. Clinical Manifestations - Deformity  Specific to involved joint – Heberden’s & Bouchard’s nodes • Indication of osteophyte formation & loss of joint space • Appear from age 40 & tend to be seen in families • Often red, swollen & tender • Do not cause significant loss of function
  19. 19. Hand Deformormities - Nodes
  20. 20. Osteoarthritis Hands
  21. 21. Clinical Manifestations  Deformity – Bouchard’s nodes • PIP joints – Nodes often red, swollen, tender

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