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Osteoarthritis
- 2. Definition Osteoarthritis is a group of overlapping distinct diseases, which may have different etiologies but with similar biologic, morphologic, and clinical outcomes. The disease processes not only affect the articular cartilage, but involve the entire joint, including the •subchondral bone, •ligaments, •capsule, •synovial membrane, and •periarticular muscles. Ultimately, the articular cartilage degenerates with •fibrillation, •fissures, •ulceration, and •full thickness loss of the joint surface.
- 4. FACTS Most common type of arthritis Cartilage loss + peri articular bone loss Mechanical factors play a central role Increases with age Females > males Familial pattern of inheritance - nodal
- 6. PATHOLOGY • Destruction of articular cartilage • Subchondral bone sclerosis • Osteophyte formation • Thickening and inflammation of synovial membrane • Subchondral cyst formation
- 11. Aetiology • Genetic • Obesity • Hereditary • Gender • Hypermobility • Trauma- fracture via cyst • Congenital joint dyplasia • Joint congruity • Occupation – manual workers • Sports – repetitive injury
- 13. Clinical features • Hip and knee more common • Some flare up due to inflammation – high ESR & CRP • Commonly affected • DIPJ • Base of the thumb • Base of the big toe • Vertebrae • Hip • Knee • Rarely affected • Elbow • Wrist • Ankle • Focal synovitis- by fragments shed by bone cartilage
- 15. Symptoms • Worse with weight bearing • Improved by restJoint pain • Early morning joint stiffness <30 minsJoint gelling Joint instability • Poor gait • In hand, low gripping strengthLoss of function
- 16. Signs • Joint tenderness • Crepitus • Limitation of range of movements • Joint instability • Joint effusion and variable level of inflammation • Bone swelling • Wasting of muscles
- 17. Osteoarthritis • Nodal • Hip • Knee Localized • Primary erosive • Crystal associatedGeneralized
- 18. Nodal Osteoarthritis • DIP joints> PIP joints • Enthesitis • Heberden’s nodes – DIP joints • Bouchard’s nodes – PIP joints • X ray • Marginal osteophytes • Joint space loss (in >60y, even without symptoms) • Squared hands • Bone swellings of carpometacarpal joint and fixed adduction of thumb
- 21. What are the features suggestive of osteoarthritis in these hands?
- 22. Knee osteoarthritis • Females>males • Strong relationship with obesity • Generally bilateral • Medical compartment > lateral compartment • Risk factors • Previous trauma • Meniscal cruciate ligament injury
- 23. Knee joint OA
- 24. Investigation Blood tests • ESR – normal • High sensitive CRP – slightly increased • Rheumatoid factor – negative • ANA – negative X ray • Narrow joint space • Cartilage destruction • Subchondral sclerosis and cyst formation • New bone formation – osteophytes MRI • Meniscal injury • Early cartilage injury • Subchondral bone changes Arthroscopy • Early fissuring • Surface erosion of cartilage Synovial fluid aspiration • Viscous fluid • Few leukocytes • Occasional calcium pyrophosphate crystals
- 25. X ray features of osteoarthritis • L – loss of joint space • O – osteophytes • S – subchondral sclerosis • S – subchondral cysts
- 27. Physical management • Weight loss • Exercise • Hydrotherapy • Local heat, ice pack, massage • Local NSAID gel
- 28. Medical management • Simple anaelgesics • NSAIDs or Coxibs • Oral or topical intermittently when there is painful effusion • Intra articular corticosteroid injection into the same joint • glutasamine and chondroitin sulphate • Efficacy not proven
- 29. Surgical management • Indications • Uncontrollable (nocturnal) pain • Progressive limitation of activities of daily living
- 30. Thank You