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  1. 1.  Diagnosis of Osteoarthritis Risk factors for Osteoarthritis Treating active persons with Osteoarthritis
  2. 2. Disease of the joints characterized by:– Progressive articular cartilage loss– New subchondral bone formation– New bone and cartilage formation at joint margins– Low level synovitis & PAIN!
  3. 3.  OA is a group of diseases and mechanical abnormalities entailing degradation of joints, including articular cartilage and the subchondral bone next to it OA is derived from the Greek word ‘ostoe’, meaning ‘of the bone’, ‘arthro’, meaning ‘joint’, and ‘itis’, meaning inflammation
  4. 4.  Also known as degenerative joint disease or “wear and tear arthritis”. Progressive loss of cartilage with remodeling of subchondral bone and progressive deformity of the joint (s). Cartilage destruction may be a result of a variety of etiologies
  5. 5.  Joint space narrowing Subchondral sclerosis Marginal osteophytes Subchondral cyst
  6. 6.  Joint trauma Age  Obesity (knee, hip,  10-fold increase from 3065 hand)  Occupation Genetics (generalized)  Abnormal joint Gender biomechanics  Men <50: higher risk  Dysplasia, malalignment,  Women >50: higher risk instability, abnormal innervation Nutritional  Low vitamin C and D intake  Knee extensor wkness  Sports w/ joint risk Systemic Risk Factors Joint Biomechanical Risk Factors
  7. 7.  Obesity Heredity Gender Hypermobility Osteoporosis Trauma Congenitaljoint dysplasia Occupation Sport
  8. 8. Primary OA: No known causeSecondary OA Pre-existing joint damage: RA, Gout, Seronegative spondyloarthropathy, Septic arthritis, Pagets disease, Avascular necrosis, e.g. corticosteroid therapy Metabolic disease: Chondrocalcinosis, Hereditary haemochromatosis, Acromegaly Systemic diseases: Haemophilia- recurrent haemarthrosis, Haemoglobinopathies, e.g. sickle cell disease, Neuropathies
  9. 9. Signs Joint tenderness Crepitus on movement Limitation of range of movement Joint instability Joint effusion and variable levels of inflammation Bony swelling Wasting of muscles.
  10. 10. Generally speaking, the process of clinically detectable osteoarthritis is IRREVERSIBLEand typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint
  11. 11.  Non pharmocologic Measures  Education, Weight loss, Exercise, & Bracing Pharmacologic Measures  Analgesics, Glucosamine, Injectables Alternative Therapies  Acupuncture, Magnets, Balneotherapy, Thermotherapy Surgery
  12. 12.  Weight control Appropriate rest and Exercise Physical therapies Occupational therapies
  13. 13.  Medial or lateral unloading
  14. 14.  Glucoseamine, chondroitin sulphate, antioxidants, others…SPECIFIC MEDICATIONS Paracetamol NSAIDs COX-2 selective inhibitors Corticosteroids
  15. 15.  I recommend in ALL patients with knee and hip OA  GS 1500 mg/ CS 800 mg 3 month trial, evaluate efficacy; continue if helping Consider indefinite use even if no pain relief for joint space preservation
  16. 16. Based on research dating back to the 1980’s Increases the viscosity and elasticity of OA synovial fluid Stimulates endogenous hyaluronic acid production Inhibits induction and activity of degradative enzymes Reduces inflammatory response Analgesic effect
  17. 17.  TENS effective in some with knee or hip OA  Short-term, 2-4 weeks Acupuncture relieves pain Heat/Ice thermotherapy Balneotherapy
  18. 18.  Arthroscopy Cartilage transplantation Joint replacement
  19. 19.  NOBENEFIT for unselected OA (mechanical or inflammatory causes)
  20. 20.  Universally recommended to improved pain, function, QOL  Unicompartmental  Total joint replacement
  21. 21.  Implantation of chondrocytes Local injection of hyaluronic acid Topical treatment Surgical treatment Acupuncture