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  1. 1. OsteoarthritisFrom Wikipedia, the free encyclopediaJumpOsteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease orosteoarthrosis, is a group of mechanical abnormalities involving degradation of joints,[1]including articular cartilage and subchondral bone. Symptoms may include joint pain,tenderness, stiffness, locking, and sometimes an effusion. A variety of causes—hereditary,developmental, metabolic, and mechanical—may initiate processes leading to loss of cartilage.When bone surfaces become less well protected by cartilage, bone may be exposed anddamaged. As a result of decreased movement secondary to pain, regional muscles may atrophy,and ligaments may become more lax.[2]Treatment generally involves a combination of exercise, lifestyle modification, and analgesics. Ifpain becomes debilitating, joint replacement surgery may be used to improve the quality of life.OA is the most common form of arthritis,[2] and the leading cause of chronic disability in theUnited States.[3] It affects about 8 million people in the United Kingdom and nearly 27 millionpeople in the United States Osteoarthritis Classification and external resourcesICD-10 M15-M19, M47ICD-9 715OMIM 165720DiseasesDB 9313MedlinePlus 000423 med/1682 orthoped/427 pmr/93eMedicine radio/492MeSH D010003
  2. 2. Contents 1 Signs and symptoms 2 Causes o 2.1 Primary o 2.2 Secondary 3 Diagnosis o 3.1 Classification 4 Management o 4.1 Lifestyle modification o 4.2 Physical measures o 4.3 Orthotics o 4.4 Medication o 4.5 Surgery o 4.6 Alternative medicine 5 Epidemiology 6 Etymology 7 History 8 Research 9 References 10 External linksSigns and symptomsBouchards nodes and Heberdens nodes may form in osteoarthritisThe main symptom is pain, causing loss of ability and often stiffness. "Pain" is generallydescribed as a sharp ache, or a burning sensation in the associate muscles and tendons. OA cancause a crackling noise (called "crepitus") when the affected joint is moved or touched, andpatients may experience muscle spasm and contractions in the tendons. Occasionally, the jointsmay also be filled with fluid. Humid and cold weather increases the pain in many patients.[4][5]
  3. 3. OA commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hipsand knees, although in theory, any joint in the body can be affected. As OA progresses, theaffected joints appear larger, are stiff and painful, and usually feel better with gentle use butworse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.In smaller joints, such as at the fingers, hard bony enlargements, called Heberdens nodes (on thedistal interphalangeal joints) and/or Bouchards nodes (on the proximal interphalangeal joints),may form, and though they are not necessarily painful, they do limit the movement of the fingerssignificantly. OA at the toes leads to the formation of bunions, rendering them red or swollen.Some people notice these physical changes before they experience any pain.OA is the most common cause of joint effusion, sometimes called water on the knee in lay terms,an accumulation of excess fluid in or around the knee joint.[6]CausesSome investigators believe that mechanical stress on joints underlies all osteoarthritis, with manyand varied sources of mechanical stress, including misalignments of bones caused by congenitalor pathogenic causes; mechanical injury; overweight; loss of strength in muscles supportingjoints; and impairment of peripheral nerves, leading to sudden or uncoordinated movements thatoverstress joints.[7] However exercise, including running in the absence of injury, has not beenfound to increase ones risk of developing osteoarthritis.[8] Nor has cracking ones knuckles beenfound to play a role.[9]PrimaryPrimary osteoarthritis of the left knee. Note the osteophytes, narrowing of the joint space (arrow), andincreased subchondral bone density (arrow).
  4. 4. Primary osteoarthritis is a chronic degenerative disorder related to but not caused by aging, asthere are people well into their nineties who have no clinical or functional signs of the disease.As a person ages, the water content of the cartilage decreases[10] as a result of a reducedproteoglycan content, thus causing the cartilage to be less resilient. Without the protective effectsof the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradationand thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can alsooccur, though often mild (compared to what occurs in rheumatoid arthritis). This can happen asbreakdown products from the cartilage are released into the synovial space, and the cells liningthe joint attempt to remove them. New bone outgrowths, called "spurs" or osteophytes, can formon the margins of the joints, possibly in an attempt to improve the congruence of the articularcartilage surfaces. These bone changes, together with the inflammation, can be both painful anddebilitating.A number of studies have shown that there is a greater prevalence of the disease among siblingsand especially identical twins, indicating a hereditary basis.[11] Up to 60% of OA cases arethought to result from genetic factors.Both primary generalized nodal OA and erosive OA (EOA. also called inflammatory OA) aresub-sets of primary OA. EOA is a much less common, and more aggressive inflammatory formof OA which often affects the distal interphalangeal joints and has characteristic changes on x-ray.SecondaryThis type of OA is caused by other factors but the resulting pathology is the same as for primaryOA: Alkaptonuria Congenital disorders of joints Diabetes Ehlers-Danlos Syndrome Hemochromatosis and Wilsons disease Inflammatory diseases (such as Perthes disease), (Lyme disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace. Injury to joints or ligaments (such as the ACL), as a result of an accident or orthodontic operations. Ligamentous deterioration or instability may be a factor. Marfan syndrome Obesity Septic arthritis (infection of a joint )DiagnosisDiagnosis is made with reasonable certainty based on history and clinical examination.[12][13] X-rays may confirm the diagnosis. The typical changes seen on X-ray include: joint space
  5. 5. narrowing, subchondral sclerosis (increased bone formation around the joint), subchondral cystformation, and osteophytes.[14] Plain films may not correlate with the findings on physicalexamination or with the degree of pain.[15] Usually other imaging techniques are not necessary toclinically diagnose osteoarthritis.In 1990, the American College of Rheumatology, using data from a multi-center study,developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissueenlargement and swelling of certain joints. These criteria were found to be 92% sensitive and98% specific for hand osteoarthritis versus other entities such as rheumatoid arthritis andspondyloarthropathies.[16]Related pathologies whose names may be confused with osteoarthritis include pseudo-arthrosis.This is derived from the Greek words pseudo, meaning "false", and arthrosis, meaning "joint."Radiographic diagnosis results in diagnosis of a fracture within a joint, which is not to beconfused with osteoarthritis which is a degenerative pathology affecting a high incidence ofdistal phalangeal joints of female patients. A polished ivory-like appearance may also develop onthe bones of the affected joints, reflecting a change called eburnation.[17] Damaged cartilage in gross pathological specimen from sows. (a) cartilage erosion (b)cartilage ulceration (c)cartilage repair (d)osteophyte (bone spur) formation. Histopathology of osteoarthrosis of a knee joint in an elderly female.
  6. 6. Severe osteoarthritis and osteopenia of the carpal joint and 1st carpometacarpel joint.ClassificationOsteoarthritis can be classified into either primary or secondary depending on whether or notthere is an identifiable underlying cause.ManagementLifestyle modification (such as weight loss and exercise) and analgesics are the mainstay oftreatment. Acetaminophen / paracetamol is used first line and NSAIDs are only recommended asadd on therapy if pain relief is not sufficient.[18] This is due to the relative greater safety ofacetaminophen.[18]Lifestyle modificationFor overweight people, weight loss may be an important factor. Patient education has beenshown to be helpful in the self-management of arthritis. It decreases pain, improving function,reducing stiffness and fatigue, and reducing medical usage.[19] A meta-analysis has shown patienteducation can provide on average 20% more pain relief when compared to NSAIDs alone inpatients with hip OA.[19]Physical measuresFor most people with OA, graded exercise should be the mainstay of their self-management.Moderate exercise leads to improved functioning and decreased pain in people with osteoarthritis
  7. 7. of the knee.[19][8] While there is some evidence for certain physical therapies evidence for thecombined program is limited.[20]There is sufficient evidence to indicate that physical interventions can reduce pain and improvefunction.[21] There is some evidence that manual therapy is more effective than exercise for thetreatment of hip osteoarthritis, however this evidence could be considered to be inconclusive.[22]Functional, gait, and balance training has been recommended to address impairments ofproprioception, balance, and strength in individuals with lower extremity arthritis as these cancontribute to higher falls in older individuals.[23]OrthoticsThe use of orthoses (commonly referred to as splints, braces or insoles as applicable) can reducethe symptoms of osteoarthritis at various joints. In the lower limb, orthoses are used for the footand ankle [24] and knee [25]. In the upper limb, splinting of the base of the thumb leads toimprovements after one year.[26]MedicationAnalgesicsAcetaminophen is the first line treatment for OA.[18][27] For mild to moderate symptomseffectiveness is similar to non-steroidal anti-inflammatory drugs (NSAIDs), though for moresevere symptoms NSAIDs may be more effective.[18] NSAIDs such as ibuprofen while moreeffective in severe cases are associated with greater side effects such as gastrointestinalbleeding.[18] Another class of NSAIDs, COX-2 selective inhibitors (such as celecoxib) areequally effective to NSAIDs with lower rates of adverse gastrointestinal adverse effects buthigher rates of cardiovascular disease such as myocardial infarction.[28] They are also much moreexpensive. There are several NSAIDs available for topical use including diclofenac. They havefewer systemic side-effects and at least some therapeutic effect.[29] While opioid analgesic suchas morphine and fentanyl improve pain this benefit is outweighed by frequent adverse events andthus they should not routinely be used.[30]OtherOral steroids are not recommended in the treatment of OA because of their modest benefit andhigh rate of adverse effects. Injection of glucocorticoids (such as hydrocortisone) leads to shortterm pain relief that may last between a few weeks and a few months.[31] Topical capsaicin andjoint injections of hyaluronic acid have not been found to lead to significant improvement.[29][32]Hyaluronic acid injects have been associated with significant harm.[32]SurgeryIf disability is significant and the above management is ineffective, joint replacement surgery orresurfacing may be recommended. Evidence supports joint replacement for both knees andhips.[33] For the knee it improves both pain and functioning.[34] Arthroscopic surgical intervention
  8. 8. for osteoarthritis of the knee however has been found to be no better than placebo at relievingsymptoms.[35]Alternative medicineMany alternative medicines are purporting to decrease pain associated with arthritis. However,there is little evidence supporting benefits for most alternative treatments including: vitamin A,C, and E, ginger, turmeric, omega-3 fatty acids, chondroitin sulfate and glucosamine. Thesetreatments are thus not recommended.[36][37] Glucosamine was once believed to be effective,[38]but a recent analysis has found that it is no better than placebo.[39] S-Adenosyl methionine mayrelieve pain similar to nonsteroidal anti-inflammatory drugs.[38][40] While electrostimulationtechniques (NEST) have been used for twenty years to treat osteoarthritis in the knee, there is noevidence to show that it reduces pain or disability.[41] Three studies support the use of catsclaw.[36]AcupunctureA Cochrane review found that while acupuncture leads to a statistically significant improvementin pain relief, this improvement is small and may be of questionable clinical significance.Waiting list-controlled trials for peripheral joint osteoarthritis do show clinically relevantbenefits, but these may be due to placebo effects.[42] Acupuncture does not seem to produce long-term benefits.[43]GlucosamineControversy surrounds glucosamine.[44] A 2010 meta-analysis has found that it is no better thanplacebo.[39] Some older reviews conclude that glucosamine sulfate was an effectivetreatment[45][46] while some others have found it ineffective.[47][48] A difference has been foundbetween trials involving glucosamine sulfate and glucosamine hydrochloride, with glucosaminesulfate showing a benefit and glucosamine hydrochloride not. The Osteoarthritis ResearchSociety International (OARSI) recommends that glucosamine be discontinued if no effect isobserved after six months.[49]EpidemiologyDisability-adjusted life year for osteoarthritis per 100,000 inhabitants in 2004.[50] no data 300–320
  9. 9. ≤ 200 320–340 200–220 340–360 220–240 360–380 240–260 380–400 260–280 ≥ 400 280–300Osteoarthritis affects nearly 27 million people in the United States, accounting for 25% of visitsto primary care physicians, and half of all NSAID prescriptions. It is estimated that 80% of thepopulation have radiographic evidence of OA by age 65, although only 60% of those will havesymptoms.[51] In the United States, hospitalizations for osteoarthritis increased from 322,000 in1993 to 735,000 in 2006.[52]Globally osteoarthritis causes moderate to severe disability in 43.4 million people as of 2004.[53]EtymologyOsteoarthritis is derived from the Greek word part osteo-, meaning "of the bone", combined witharthritis: arthr-, meaning "joint", and -itis, the meaning of which has come to be associated withinflammation. The -itis of osteoarthritis could be considered misleading as inflammation is not aconspicuous feature. Some clinicians refer to this condition as osteoarthosis to signify the lack ofinflammatory response.HistoryEvidence for osteoarthritis found in the fossil record is studied by paleopathologists, specialistsin ancient disease and injury. Osteoarthritis has been reported in fossils of the large carnivorousdinosaur Allosaurus fragilis.[54]ResearchThere are ongoing efforts to determine if there are agents that modify outcomes in osteoarthritis.There is tentative evidence that strontium ranelate may decrease degeneration in osteoarthritisand improve outcomes.[55][56]