1. Dr M. Nadeem
Assistant Prof Medicine
Islamabad Medical and Dental college

2.  Osteoarthritis is a non-inflammatory,
degenerative condition of joints Characterized
by degeneration of articular cartilage and
formation of new bone i.e. osteophytes

3.  Internationally, osteoarthritis is the most
common articular disease
 Estimates of its frequency vary across different
populations
 Primary osteoarthritis is a common disorder of
the elderly
 Approximately 80-90% of individuals older
than 65 years have evidence of radiographic
primary osteoarthritis

4.  prevalence of the disease increases
dramatically among persons older than 50
years
 In individuals older than 55 years, the
prevalence of osteoarthritis is higher among
women than among men
 Osteoarthritis is more common in whites than
in blacks

5.  In early osteoarthritis, swelling of the cartilage
usually occurs
 Over time, the loss of cartilage results in loss of
joint space
 Bone denuded of its protective cartilage
 The subchondral bone responds with vascular
invasion and increased cellularity, becoming
thickened and dense
 At areas along the articular margin there is
irregular outgrowth of new bone (osteophytes)

6.  Along with joint damage, osteoarthritis may
also lead to pathophysiologic changes in
associated ligaments and the neuromuscular
apparatus
 Although osteoarthritis has been classified as a
noninflammatory arthritis
 Increasing evidence has shown that
inflammation occurs as cytokines and
metalloproteinases are released into the joint

7. Right: Early OA with
area of cartilage loss in
the center.
Left: More advanced
changes with extensive
cartilage loss and
exposed underlying
bone

10.  Age
 Female versus male sex
 Obesity
 Lack of osteoporosis
 Occupation
 Sports activities
 Previous injury
 Muscle weakness
 Proprioceptive deficits
 Genetic elements
 Acromegaly
 Calcium crystal deposition disease

11. OA
Primary OA Secondary OA

12.  More common than secondary OA
 Cause –Unknown
 Common-in elders where there is no previous
pathology.
 Its mainly due to wear and tear changes
occuring in old ages mainly in weight bearing
joints.

13.  Due to a predisposing cause such as:
1.Injury to the joint
2.Previous infection
3.RA
5.Deformity
6.Obesity
7.hyperthyriodism

14.  The progression of osteoarthritis is
characteristically slow, occurring over several
years or decades
 Joint pain in weight bearing joints like knee,
spine and hip
 Deep, achy joint pain exacerbated by extensive
use
 reduced range of motion and crepitus are
frequently present

15.  Stiffness during rest (gelling) may develop,
with morning joint stiffness usually lasting for
less than 30 minutes
 Initially, pain can be relieved by rest and may
respond to simple analgesics
 However, joints may become unstable as the
osteoarthritis progresses

16.  Physical examination findings in patients with
osteoarthritis are mostly limited to the affected
joints
 Reduced range of motion and crepitus
 Most cases of osteoarthritis do not involve
erythema or warmth over the affected joint(s)
 Effusion may be present
 Muscle atrophy around a more severely
affected joint may occur

17.  Heberden nodes, which represent palpable
osteophytes in the DIP joints
 Bouchard's nodes at proximal interphalangeal
joints

18. Nodal osteoarthritis
Note bony
enlargement of distal
and proximal
interphalangeal
joints (Heberden's
nodes and
Bouchard's nodes,
respectively).

19.  Rheumatoid ArthritisRheumatoid Arthritis
 GoutGout
 CPPD (Calcium pyrophosphate crystalCPPD (Calcium pyrophosphate crystal
deposition disease)deposition disease)
 Septic JointSeptic Joint
 Polymyalgia RheumaticaPolymyalgia Rheumatica

20.  OA is diagnosed on the basis of clinical
findings and radiographic changes
 Now specific lab investigations

21.  Joint space narrowingJoint space narrowing
 Subchondral sclerosisSubchondral sclerosis
 Marginal osteophytesMarginal osteophytes
 Subchondral cystSubchondral cyst

22. Asymmetrical joint space narrowing from loss of
articular cartilage
The medial (inside) part of the knee is most commonly affected by osteoarthritis.
OA – Radiographic Diagnosis

23. OA – Radiographic Diagnosis
•Asymmetrical
joint space
narrowing
•Periarticular
sclerosis
•Osteophytes
•Sub-chrondral
bone cysts

24.  OA typically asymmetricalOA typically asymmetrical
Paget’s disease

25. OA – Arthroscopic Diagnosis
Arthroscopy allows earlier
diagnosis by demonstrating the
more subtle cartilage changes
that are not visible on x-ray

26.  Severe, acute joint pain is anSevere, acute joint pain is an
uncommon manifestation of OAuncommon manifestation of OA
 Clear fluid WBC <2000/mm3Clear fluid WBC <2000/mm3
 Normal viscosityNormal viscosity

27.  Weight LossWeight Loss
 Ten-pound weight loss over 10 years decreased theTen-pound weight loss over 10 years decreased the
odds for developing knee OA by 50%odds for developing knee OA by 50%
 Even a modest amount of weight loss may beEven a modest amount of weight loss may be
beneficialbeneficial
 RestRest
 Short period of time, typically 12-24 hoursShort period of time, typically 12-24 hours
 Prolonged rest can lead to muscle atrophy andProlonged rest can lead to muscle atrophy and
decreased joint mobilitydecreased joint mobility

28.  Patient education
 Heat and cold
 Exercise
 Physical therapy
 Occupational therapy

29.  Topical capsaicin
 Topical nonsteroidal anti-inflammatory drugs
(NSAIDs) - Including trolamine salicylate
 Oral NSAIDs
 Tramadol
 Intra-articular corticosteroid injections
 Glucosamine and chondroitin sulfate have
been used in Europe for many years and
continue to be popular with patients
worldwide

30.  A referral to an orthopedic surgeon may be
necessary if the osteoarthritis fails to respond
to a medical management plan
 Arthroscopy
 Osteotomy
 Arthroplasty - Particularly with knee or hip
osteoarthritis
 Fusion