Osteoarthritis types of osteoarthritis treatment of osteoarthritis

1. Osteoarthritis
By
Bapan Paul

2. What is Arthritis?
Acute or chronic inflammation of a joint, often
accompanied by pain and structural changes and having
diverse causes, as infection, crystal deposition, or injury

3. Osteoarthritis
Osteoarthritis is non inflammatory degenerative
condition of joints characterized by degeneration of
articular cartilage and formation of new bone i.e.
osteophytes.

4. Development of Osteoarthritis

5. •Affect DIP, PIP, 1st
Carpometacarpal, knee, hip,
spine
Primary OA
(Idiopathic)
•Affect less common joint as
wrist, metacarpophalangeal,
shoulder.
Secondary
OA
Types of Osteoarthritis

6. Risk Factors
PRIMARY
 Age
 Gender
 Obesity
 High Bone Mass
 Mechanical : Repetitive
bone use squatting
SECONDARY
 Injury to joint : Traumatic or
inflammatory
 Heamoartharosis
 Congenital/Developmental
 Neuropathic joint
 Metabolic (Paget's Disease)

7. Macro structural & Pathological Changes
Macro structural
 Loss of articular cartilage
 Subchondral cyst
 Osteophytes
 Sclerosis
 Muscle wasting
Pathological
 Cartilage Fibrilation
 Subchondral new bone
 Myxoid degeneration
 Trabecular compression

8. Sign & Symptoms
• Pain
• Tenderness
• Stiffness
• Loss of flexibility
• Grating sensation
• Crepitus
• Bone spurs

9. Knee OA
The classical criteria for OA of knee
is based upon the presence of knee
pain plus at least 3 of the following
6 clinical characteristics
1. Age >> 50 years
2. Morning stiffness for < 30
minutes
3. Crepitus on active motion of
knee
4. Bony tenderness
5. Bony enlargement
6. No palpable warmth

10. Hand OA
The classical criteria for OA of hand is based
upon the presence of hand aching or stiffness
plus at least 3 of the following 4 features
1. Hard tissue enlargment of 2 or more of 10
selected joint. The 10 selected joints are
the second and third distal
interphalangeal (DIP) joints, second and
third proximal interphalageal (PIP) joints
and the first carpometacarpal (CMC) of
both hands.
2. Hard enlargement of two or more DIP
joints.
3. Fewer than 3 swollen
metacarpophalangeal (MCP) joints.
4. Deformity of atleast 1 of the 10 selected
joints.

11. Hip OA
The presence of hip pain plus
at least two of the following 3
features
1. ESR of less than 20mm/h
2. Radiographic osteophytes
(femoral or acetabular)
3. Joint space narrowing on
radiography (superior,
axial or medial)

12. Spine OA
Most common at C5, T8 and L3
1. OA of spine is a
breakdown of the
cartilage of the joints and
discs in the neck and
lower back.
2. OA produces spurs that
put pressure on the
nerves leaving the spinal
column.

13. Diagnosis
• Pain Radiography
• MRI
• Bone Scanning
• Synovial Fluid Analysis

14. Therapeutic Approach to Osteoarthritis

15. Therapeutic Approach to Osteoarthritis
Acetaminophen
 Dose 650 to 1000 mg up to 4
times per day
NSAID Therapy
 Short acting NSAIDs
(ibuprofen )
 Long acting NSAIDs
(diclofenac , naproxen ,
nabumetone) – greater relief
 COX2 inhibitors (celecoxib)
Opioids
 Only when acetaminiphen or
NSAIDs fail
 Starts with low dose
 Tramadol and Duloxetine
Diacerein
 Blocks interleukin-1
 Disease modifier for OA.
Daicerein increase proteoglycans
and hyaluronan

16. NSAID - MOA

17. Opioids - MOA

18. Diacerein - MOA
1.
Matrix metalloproteinases

19. Complementary and Alternative
Medicines
• Intra articular injection for corticosteroids or
hyaluronic acid
• Acupuncture
• Heat and Cold
• Glucosamine/Chondroitin
• Synovial Fluid Supplements
• Capsaicin Cream
• Diclofenac Gel

20. Surgical
• Arthroscopy
• Osteotomy
• Arthroplasty