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Osteoarthritis

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Osteoarthritis
Osteoarthritis
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Osteoarthritis

  1. 1. OSTEOARTHRITIS PRESENTED BY: SAPEEDEH AFZAL ROLL # 10 GROUP: A-1
  2. 2. ROAD MAP • PROTECTIVE MECHANISM OF SYNOVIAL JOINTS • WHAT IS OA • EPIDEMIOLOGY • DISTRIBUTION OF DISEASE. • AETIOLOGY & RISK FACTORS • PATHOGENESIS • CLINICAL FEATURES • DIFFERENTIAL DIAGNOSIS • INVESTIGATIONS • MANAGEMENT
  3. 3. PROTECTIVE MECHANISM OF SYNOVIAL JOINTS
  4. 4. WHAT IS OSTEOARTHRITIS ??? Osteoarthritis is a degenerative disease of synovial joints characterized by focal loss of articular hyaline cartilage with proliferation of new bone & remodeling of joint contour.
  5. 5. EPIDEMIOLOGY • Weight bearing joints e.g. knee & hip joints. • Age > 65 years. – 80% have radiographic features. – 25-30% have symptoms. • More common in women. • Familial tendency.
  6. 6. DISTRIBUTION OF DISEASE
  7. 7. ETIOLOGY • PRIMARY / IDIOPATHIC: When there is no obvious predisposing factor. Common form of OA. • SECONDARY: When degenerative joint changes occur in response to a recognizable local or systemic factor.
  8. 8. CAUSES OF SECONDARY OSTEOARTHRITIS
  9. 9. RISK FACTORS AGEING CONSTITUTIONAL SUSCEPTIBILITY MECHANICAL FACTORS
  10. 10. PATHOGENESIS • Progressive destruction & loss of articular cartilage with an accompanying peri-articular bone response leads to exposure of sub-chondral bone which becomes sclerotic, with increased blood vascularity & cyst formation.
  11. 11. CLINICAL FEATURES • Pain: – Activity & weight-bearing related, relieved by rest. – Variable over time. – Only one or few joints involved. • Morning stiffness only brief <30 minutes. • Restricted functionality: – Capsular thickening. – Blocking by osteophytes.
  12. 12. CLINICAL FINDINGS IN NODAL GENERALIZED OA • Presentation typically in women. (40 & 50 years) • Pain. • Stiffness. • Swelling of one or few finger interphalangeal joints ( distal > proximal). • Heberden’s nodes (+/- Bouchard’s nodes). • Involvement of first carpometacarpal joint is common. • Predisposition to OA at other joints specially knees.
  13. 13. CLINICAL FINDINGS IN KNEE OA • Targets patello-femoral & medial tibio-femoral compartments of knee. • Pain is localized to anterior or medial aspect of knee & upper tibia. • Jerky gait. • Varus deformity. • Joint line &/or periarticular tenderness. • Weakness & wasting of quadriceps muscle. • Restricted extension & flexion. • Bony swelling around joint.
  14. 14. CLINICAL FINDINGS IN HIP OA • Targets mostly superior aspect & less commonly medial aspect of joint. • Pain is maximally deep in groin area. • Antalgic gait. • Weakness & wasting of muscles (quadriceps & gluteal). • Pain & restricted internal rotation with flexion.
  15. 15. CLINICAL FINDINGS IN EARLY- ONSET OA • Before the age of 45 years. • Single or multiple joint involvement. • Typical signs & symptoms of OA.
  16. 16. CLINICAL FEATURES IN EROSIVE OA • Preferentially targeting proximal IPJs. • Common development of IPJ lateral instability. • Sub-chondral erosions on x-rays. • Ankylosis of IPJs.
  17. 17. DIFFERENTIAL DIAGNOSIS FEATURES OSTEOARTHRITIS RHUEMATOID ARTHRITIS GOUT PRESENCE OF SYMPTOMS AFFECTING THE WHOLE BODY: Systemic symptoms are not present. Frequent fatigue and a general feeling of being ill are present Chills and a mild fever along with a general feeling of malaise may also accompany the severe pain and inflammation DURATION OF MORNING STIFFNESS: Morning stiffness lasts less than 30-60 mins; Morning stiffness lasts longer than 1 hour. Not seen NODULES: Heberden's & bouchard's nodes Heberden’s nodes are absent. PAIN WITH MOVEMENT: Movement increases pain Movement decreases pain AGE OF ONSET: Most commonly occurs in individuals over the age of 50. Usual age of onset is 20- 40 years. Usually over 35 yrs of age in men and after menopause in females LAB FINDINGS: Ra factor & anti-ccp antibody negative. Normal esr & c-reactive protein. Ra factor & anti-ccp antibody positive. Esr & c- reactive protein elevated. Joint fluid microscopy is diagnostic.
  18. 18. INVESTIGATIONS • PLAIN X-RAY: – JOINT SPACE NARROWING – SUBCHONDRAL SCLEROSIS
  19. 19. MARGINAL OSTEOPHYTES
  20. 20. SUBCHONDRAL CYST
  21. 21. • BLOOD TEST: – FBC NORMAL. – ESR NORMAL. – CRP NORMAL. – RHEUMATOID FACTOR NEGATIVE. • SYNOVIAL FLUID ANALYSIS: – VISCOUS WITH LOW TURBIDITY. – CPPD & CALCIUM PHOSPHATE. INVESTIGATIONS
  22. 22. MANAGEMENT
  23. 23. NON-PHARMACOTHERAPY – Full explanation of the condition via patient education: • Properly position and support your neck and back while sitting or sleeping. • Adjust furniture, such as raising a chair or toilet seat. • Avoid repeated motions of the joint, especially frequent bending. • Lose weight if you are overweight or obese, which can reduce pain and slow progression of OA. • Exercise each day. • Build confidence.
  24. 24. NON-PHARMACOTHERAPY • Exercises: • Aerobic conditioning. • Muscle strengthening exercises. • Reduction of adverse mechanical factors: • Weight loss. • Pacing of activities. • Appropriate footwear.
  25. 25. PHARMACOTHERAPY PARACETAMOL •Initial drug of choice •Orally 1 gm 6-8 hourly NSAIDs •Indicated as needed. •Oral e.g: ibuprofen & coxibs •Topically e.g: capsaicin 0.025% cream WEAK OPIOIDS •Occasionally required. •e.g: dihydrocodeine INTRA-ARTICULAR CORTICOSTEROIDS INJECTIONS •3-5 weekly. HYALURONIC INJECTIONSHYALURONIC INJECTIONS •Injections for 3-5 weeks.Injections for 3-5 weeks. •Pain relief for several months.
  26. 26. SURGICAL TREATMENT • Should be considered for those who do not give response to pharmacotherapy. – Osteotomy. – Joint replacement. – Total joint replacement.

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