Osteoarthritis is a degenerative joint disease characterized by cartilage breakdown. It is the most common form of arthritis, often affecting the knees in 70% of people over age 60. Osteoarthritis can cause functional impairment and disability in older adults and is a leading cause of joint replacement surgery. Risk factors include age, obesity, genetics, and joint trauma. Treatment focuses on reducing pain and preserving function through lifestyle changes, physical therapy, braces, and medications like acetaminophen, NSAIDs, and opioids. Surgery is considered for severe, treatment-resistant cases.

1. OSTEOARTHRITIS
DR. TAREK NASRALLAH
ASS. PROF.
RHEUMATOLOGY
AL AZHAR UNIVESITY

2. Osteoarthritis (OA): is a degenerative joint
disease characterized by the breakdown of the
joint's cartilage. It called degenerative joint
disease.
the most common form of arthritis.

3. EPIDEMIOLOGY
Osteoarthritis(OA) is the most common
joint disease
OA of the knee joint is found in 70% of
the population over 60 years of age
Radiological evidence of OA can be
found in over 90 % of the population

4. LIMITED FUNCTION
OA may cause functional loss of daily
living Activites
Most important cause of disability in
old age
Major indication for joint replacement
surgery

5. CLASSIFICATION OF OA
Primary OA Secondary OA
Etiology is unknown Etiology is known

6. AGE
Primary OA > 40 years
Direct correlation
Aging process

7. RISK FACTORS FOR PRIMARY OA
Age
Sex
Obesity
Genetics
Trauma (daily)

8. SECONDARY OSTOARTHRITIS
Trauma
Previous joint disorders;
Congenital hip dislocation
Infection: Septic arthritis, Brucella, Tb
Inflammatory: RA, AS
Metabolic: Gout
Hematologic: Hemophilia
Endocrine: DM

9. ETIOLOGY OF OA
Cartilage properties
Biomechanical problem

11. PATHOLOGY OF OA
 Fibrillation
 Eburnation
 Osteophytes
 Subcondral cysts

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 Natural history of OA: Progressive
cartilage loss, subchondral thickening,
marginal osteophytes

14. CLINIC OF OA
SIGNS AND SYMPTOMS
 Joint pain - degenerative
 Stiffness following inactivity – 30 min
 Limitation of ROM – later stages
 Deformity – restricition of ADL

15. OA OF KNEE JOINT
 More common in obese females
 over 50 years of age
 Joint stiffness (<30 minutes)
 Mechanical pain
 Physical examination findings: Crepitus
 Pain on pressure
 Painful ROM and functional limitation
 Limitation of ROM in later stages of OA (first
extension)
 Laboratory analysis within normal limits

16. Morphology of Primary OA

17. Primary Generalized OA

22. LABORATORY FINDINGS OF OA
• There are no pathognomonic laboratory
findings for OA
• Laboratory analysis is performed for
differential diagnosis

23. RADIOLOGIC FINDINGS OF OA
• Narrowing of joint space
(due to loss of cartilage)
• Osteophytes
• Subchondral (paraarticular) sclerosis
• Bone cysts

26. Distal and Proximal Interphalangeal
Joints

27. • Radiograph shows
severe changes
• Most common
location in hand
• May cause
significant loss of
function
Carpometacarpal Joint

30. X-RAY OF HIP OA

31. Peripheral Joints
• Hands
• Feet

32. • X-ray shows
osteophytes,
subchondral
sclerosis, and
complete loss of joint
space
• Patients often
present with deep
groin pain that
radiates into the
medial thigh
Hip Joint

33. Secondary OA: Diabetic Neuropathy
• MTPs 2 to 5 involved
in addition to the 1st
bilaterally
• Destructive changes
on x-ray far in excess
of those seen in
primary OA
• Midfoot involvement
also common

34. Underlying Disease Associations of
OA and CPPD Disease (pseudogout)
• Hemochromatosis
• Hyperparathyroidism
• Hypothyroidism
• Hypophosphatasia
• Hypomagnesemia
• Neuropathic joints
• Trauma
• Aging, hereditary

35. TREATMENT OF OA
• Symptomatic treatment
• Structure modifying treatment
• Surgical treatment

36. STRUCTURE MODIFYING TREATMENT
• Hyaluronic acid injection (HA)
• Glycose amino glycans (GAG)

37. PRIMARY PREVENTION OF OA ??
• Regular exercises
• Weight control
• Prevention of trauma

38. AIMS OF OA TREATMENT
• Pain relief
• Preservation and restoration of joint
function
• Education

39. Non-Pharmacologic Treatment of OA
• Patient education
• Weight loss (if overweight)
• Aerobic exercise programs
• Physical therapy
• Range-of-motion exercises
Muscle-strengthening exercises
• Assistive devices for ambulation
Patellar taping
Appropriate footwear
Lateral-wedged insoles (for genu varum)
• Bracing
• Occupational therapy
• Joint protection and energy conservation

40. PHARMACOLOGIC TREATMENT OF OA
• Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
• Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
• Topical agents

41. Nonopioid Analgesic Therapy
• First-line—Acetaminophen
• Pain relief comparable to NSAIDs, less toxicity
• Beware of toxicity from use of multiple
acetaminophen-containing products
• Maximum safe dose = 4 grams/day

42. Nonopioid Analgesic Therapy (cont’d)
• NSAIDs
• Use generic NSAIDs first
• If no response to one may respond to another
• Lower doses may be effective
• Do not retard disease progression
• Gastroprotection increases expense
• Side effects: GI, renal, worsening CHF, edema
• Antiplatelet effects may be hazardous

43. Nonopioid Analgesics in OA
• Cyclooxygenase-2 (COX-2) inhibitors
• Pain relief equivalent to older NSAIDs
• Probably less GI toxicity
• No effect on platelet aggregation or bleeding time
• Side effects: Renal, edema
• Older populations with multiple medical problems
not tested
• Cost similar to generic NSAIDs plus proton pump
inhibitor or misoprostol
Medical Letter. 1999;41:11–12.

44. Medical Letter. 1999;41:11–12.
Nonopioid Analgesics in OA (cont’d)
• Tramadol
• Affects opioid and serotonin pathways
• Nonulcerogenic
• May be added to NSAIDs, acetaminophen
• Side effects: Nausea, vomiting, lowered seizure
threshold, rash, constipation, drowsiness,
dizziness

45. Opioid Analgesics for OA
• Codeine, oxycodone
• Anticipate and prevent constipation
• Long-acting oxycodone may have fewer CNS side
effects
• Propoxyphene
• Morphine and fentanyl patches for severe
pain interfering with daily activity and sleep

46. Topical Agents for Analgesia in OA
• Local cold or heat: Hot packs, hydrotherapy
• Capsaicin-containing topicals
• Use well supported by evidence
• Use daily for up to 2 weeks before benefit
• Compliance poor without full instruction
• Avoid contact with eyes
• Liniments = methyl salicylates
• Temporary benefit

47. OA: Intra-articular Therapy
• Intra-articular steroids
• Good pain relief
• Most often used in
knees, up to q 3 mo
• With frequent injections,
risk infection, worsening
diabetes, or CHF
• Joint lavage
• Significant symptomatic
benefit demonstrated
• Hyaluronate injections*
• Symptomatic relief
• Improved function
• Expensive
• Require series of
injections
• No evidence of long-
term benefit
• Limited to knees
* Altman, et al. J Rheumatol. 1998;25:2203.

48. OA: Unconventional Therapies
• Polysulfated glycosaminoglycans—
nutriceuticals
• Glucosamine +/- chondroitin sulfate: Symptomatic
benefit, no known side effects, long-term
controlled trials pending
• Tetracyclines as protease/cytokine inhibitors
• Under study
• Have disease-modifying potential

50. HAND OA - RESTING SPLINT

54. INDICATIONS OF SURGICAL
INTERVENTION
• Severe joint pain,
resistant to conservative treatment
methods
• Limitation of daily living activities
• Deformity, angular deviations, instability

55. INVASIVE METHODS
• Joint lavage
• Arthroscopy
• Cartilage grefting- genetic engineering
• Surgery
Osteotomy
Joint replacement

60. Osteoarthritis- !THINK! Function

61. Management