Osteoarthritis is a common joint disease that affects many sites in the body including the hands, knees, and hips. The incidence of osteoarthritis is increasing due to an aging population and rising obesity rates. There are many risk factors for osteoarthritis including age, female sex, genetics, obesity, joint injury, and abnormalities in joint shape. Local factors in the joint environment like muscle weakness, malalignment, and excessive or injurious joint loading can also increase the risk or progression of osteoarthritis. Accurately diagnosing and grading osteoarthritis involves both clinical assessment and radiographic evaluation using scales like the Kellgren-Lawrence grading system.
This document discusses osteoarthritis of the knee joint. It begins with an introduction to knee joint anatomy and osteoarthritis. Common radiological signs of osteoarthritis including joint space narrowing and osteophyte formation are described. Methods for examining and measuring osteoarthritis via imaging and radiography are outlined. Results from measurements of 67 osteoarthritic knees in Myanmar are presented, finding greater tubercle spiking and ratios in females and increasing with age. The document concludes with references.
Rheumatoid arthritis and osteoarthritisSonal Saran
Rheumatoid arthritis is a chronic inflammatory disease that predominantly affects the joints, especially small joints of the hands and feet. It is more common in women and involves symmetrical polyarticular inflammation of joints. The pathophysiology involves both cellular and humoral immune mechanisms leading to synovial membrane proliferation and cartilage/bone erosion. Osteoarthritis is the most common type of arthritis and is characterized by degeneration of joint cartilage and underlying bone, commonly affecting weight bearing joints like the hips and knees. Risk factors include age, obesity, trauma and genetics. Symptoms include joint pain, stiffness and decreased range of motion.
Osteoartritis (OA) adalah salah satu jenis artritis yang paling sering dialami oleh sebagian orang. Penyakit ini merupakan penyakit sendi degeneratif yang mempengaruhi tulang rawan persendian. OA terjadi akibat rusaknya kartilago yang melindungi dan memberi bantalan bagi sendi.
Primary osteoarthritis is a progressive degenerative disease affecting synovial joints. It is the most common form of arthritis, usually emerging in people over age 40 and prevalence rises with age. Risk factors include age, gender, genetics, obesity, injury or repetitive joint stress. The diagnosis is based on symptoms of joint pain and stiffness, physical exam findings of crepitus and limited range of motion, and characteristic features on x-ray of joint space narrowing and bone spurs. There is currently no cure for osteoarthritis and treatment aims to reduce pain and improve joint function.
Therapeutic management of knee osteoarthritis; physiotherap case studyenweluntaobed
The document discusses the therapeutic management of knee osteoarthritis. It provides background on the epidemiology and economic burden of the condition. Key points include that knee OA prevalence is rising with population aging and affects nearly 10% of those over 55 years old. Treatment involves a multidisciplinary approach including pharmacological interventions, physiotherapy, and sometimes surgery, with the overall goals of reducing pain and improving joint function and quality of life. Assessment involves evaluating pain levels, range of motion, muscle strength, and radiological imaging to determine the severity and appropriate treatment.
Osteoarthritis is a degenerative joint disease characterized by breakdown of articular cartilage and bone changes. It commonly affects weight-bearing joints and is a leading cause of disability. Risk factors include obesity, joint injury, genetics, and aging. Symptoms include joint pain and stiffness that worsens with use and improves with rest. Diagnosis is based on symptoms and confirmed with x-ray findings. Treatment focuses on reducing pain and inflammation, maintaining joint function, and managing other risk factors through lifestyle changes, physical therapy, braces, medications like acetaminophen, NSAIDs, or surgery for advanced cases.
Rheumatoid arthritis is a chronic inflammatory disease that commonly affects the small joints of the hands and feet. It results from an autoimmune response causing synovial inflammation and destruction of articular cartilage and bone. Early radiographic signs include soft tissue swelling, joint space widening, and juxta-articular osteopenia. Later findings consist of joint space narrowing, erosions, subluxations, and bony ankylosis. MRI is the best imaging modality for detecting early synovitis, bone marrow edema, and erosions. Characteristic sites of involvement include the second and third MCP and PIP joints bilaterally.
This document discusses osteoarthritis of the knee joint. It begins with an introduction to knee joint anatomy and osteoarthritis. Common radiological signs of osteoarthritis including joint space narrowing and osteophyte formation are described. Methods for examining and measuring osteoarthritis via imaging and radiography are outlined. Results from measurements of 67 osteoarthritic knees in Myanmar are presented, finding greater tubercle spiking and ratios in females and increasing with age. The document concludes with references.
Rheumatoid arthritis and osteoarthritisSonal Saran
Rheumatoid arthritis is a chronic inflammatory disease that predominantly affects the joints, especially small joints of the hands and feet. It is more common in women and involves symmetrical polyarticular inflammation of joints. The pathophysiology involves both cellular and humoral immune mechanisms leading to synovial membrane proliferation and cartilage/bone erosion. Osteoarthritis is the most common type of arthritis and is characterized by degeneration of joint cartilage and underlying bone, commonly affecting weight bearing joints like the hips and knees. Risk factors include age, obesity, trauma and genetics. Symptoms include joint pain, stiffness and decreased range of motion.
Osteoartritis (OA) adalah salah satu jenis artritis yang paling sering dialami oleh sebagian orang. Penyakit ini merupakan penyakit sendi degeneratif yang mempengaruhi tulang rawan persendian. OA terjadi akibat rusaknya kartilago yang melindungi dan memberi bantalan bagi sendi.
Primary osteoarthritis is a progressive degenerative disease affecting synovial joints. It is the most common form of arthritis, usually emerging in people over age 40 and prevalence rises with age. Risk factors include age, gender, genetics, obesity, injury or repetitive joint stress. The diagnosis is based on symptoms of joint pain and stiffness, physical exam findings of crepitus and limited range of motion, and characteristic features on x-ray of joint space narrowing and bone spurs. There is currently no cure for osteoarthritis and treatment aims to reduce pain and improve joint function.
Therapeutic management of knee osteoarthritis; physiotherap case studyenweluntaobed
The document discusses the therapeutic management of knee osteoarthritis. It provides background on the epidemiology and economic burden of the condition. Key points include that knee OA prevalence is rising with population aging and affects nearly 10% of those over 55 years old. Treatment involves a multidisciplinary approach including pharmacological interventions, physiotherapy, and sometimes surgery, with the overall goals of reducing pain and improving joint function and quality of life. Assessment involves evaluating pain levels, range of motion, muscle strength, and radiological imaging to determine the severity and appropriate treatment.
Osteoarthritis is a degenerative joint disease characterized by breakdown of articular cartilage and bone changes. It commonly affects weight-bearing joints and is a leading cause of disability. Risk factors include obesity, joint injury, genetics, and aging. Symptoms include joint pain and stiffness that worsens with use and improves with rest. Diagnosis is based on symptoms and confirmed with x-ray findings. Treatment focuses on reducing pain and inflammation, maintaining joint function, and managing other risk factors through lifestyle changes, physical therapy, braces, medications like acetaminophen, NSAIDs, or surgery for advanced cases.
Rheumatoid arthritis is a chronic inflammatory disease that commonly affects the small joints of the hands and feet. It results from an autoimmune response causing synovial inflammation and destruction of articular cartilage and bone. Early radiographic signs include soft tissue swelling, joint space widening, and juxta-articular osteopenia. Later findings consist of joint space narrowing, erosions, subluxations, and bony ankylosis. MRI is the best imaging modality for detecting early synovitis, bone marrow edema, and erosions. Characteristic sites of involvement include the second and third MCP and PIP joints bilaterally.
Osteoarthritis is characterized by cartilage loss, synovial thickening, and bone changes. It commonly affects the knees, hands, and hips. While age is a risk factor, osteoarthritis has both inflammatory and mechanical components and is influenced by hereditary, constitutional, and environmental factors like obesity and joint injury. Excess weight places mechanical stress on cartilage and adipose tissue may contribute through inflammatory cytokines. Osteoarthritis is now considered a distinct disease entity rather than simply wear and tear of aging.
This document summarizes a presentation on osteoarthritis (OA) phenotypes and risk factors. The presentation discusses evidence that OA may consist of distinct subtypes including generalized vs. joint-specific, secondary vs. primary, painful vs. non-painful, and malaligned vs. neutrally aligned joints. Identifying OA phenotypes is important for developing effective prevention and treatment strategies that may differ between subtypes.
Osteoarthritis risk factors include:
- Age, as it affects 65% of people over 65 and 80% over 80
- Excess weight and obesity, which increase mechanical stress on joints
- Past injuries, especially ligament tears or meniscal damage, which can lead to knee instability
Osteoarthritis is a common type of arthritis that affects joints, causing cartilage breakdown and pain. It most often impacts knees, hips, lower back, fingers, and neck. Risk factors include age, obesity, injury, genetics, and other diseases. Symptoms are joint pain and stiffness. Diagnosis involves physical exams, x-rays, MRI, or other imaging to view cartilage damage. Treatment focuses on reducing pain and improving function through exercise, weight control, medications, joint protection, physical therapy, and sometimes surgery. Managing osteoarthritis requires a combination of lifestyle changes and medical care.
This document provides information on the management of patients with musculoskeletal disorders. It discusses osteoarthritis, including risk factors, clinical manifestations, medical management using pharmacologic and non-pharmacologic therapies, and potential surgical interventions. It also covers pyogenic osteomyelitis and osteoporosis, defining each condition and outlining their treatment objectives, investigations and management approaches.
Osteoarthritis is a progressive degenerative joint disease characterized by the breakdown and eventual loss of articular cartilage in the joints. As cartilage breaks down, bones rub together causing pain, swelling, and loss of motion of the joints. The most common joints affected are weight-bearing joints like the hips, knees, and spine. Risk factors include age, obesity, joint injury, genetics, and repetitive joint stress from certain occupations and sports. The breakdown of cartilage is caused by an imbalance between the normal synthesis and degradation of cartilage components by chondrocytes within the cartilage. This leads to loss of cartilage cushioning between bones and development of bone spurs and cysts at the joint margins over time.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
Osteoarthritis is a common chronic, progressive, degenerative joint disease that affects cartilage and bone within a joint. It most often affects older adults but can also occur in younger people. It is a leading cause of physical disability. Osteoarthritis can be classified as primary, with no known cause, or secondary, due to an underlying condition like injury or obesity. It involves the breakdown and eventual loss of cartilage in one or more joints. Symptoms include pain, stiffness, and reduced mobility. Diagnosis is based on symptoms and confirmed with x-rays showing signs of cartilage loss. Treatment focuses on reducing pain and improving joint function through lifestyle changes, physical therapy, braces, and in some cases surgery.
Osteoarthritis is a type of joint disease that results from the breakdown of cartilage and underlying bone. It commonly affects the hands, feet, spine, and large weight-bearing joints like the hips and knees. The most common symptoms are joint pain, stiffness, and crackling noises. Risk factors include mechanical stress, excess weight, nerve impairment, and hereditary or hormonal conditions. It is diagnosed through x-rays, blood tests, and examination and shows features like bone spurs, cysts, and cartilage loss.
Structural Targets for Prevention of Post Traumatic OAOARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
This document provides an overview of osteoarthritis of the knee, including definition, risk factors, clinical features, diagnosis, treatment options, and surgical considerations. It defines osteoarthritis as cartilage failure induced by genetic and biomechanical factors. Risk factors include age, obesity, injury history. Clinical diagnosis is based on symptoms of pain and stiffness, physical exam findings of crepitus and limited range of motion. Treatment includes weight loss, exercise, braces, medications like acetaminophen, NSAIDs, and injections. Surgery such as arthroscopic debridement or joint replacement may be considered for advanced cases.
Osteoarthritis and rheumatoid arthritis are chronic joint disorders. Osteoarthritis involves the progressive breakdown of articular cartilage in a joint. It is associated with aging and risk factors like obesity, joint injury, and genetics. Rheumatoid arthritis is an autoimmune disease where the immune system attacks the joints, causing pain, stiffness, and swelling. It can eventually damage cartilage and bone within joints and may affect other organs. Both diseases are diagnosed based on symptoms, physical exam, x-rays, and blood tests. Treatment focuses on reducing pain and inflammation, maintaining joint mobility, and may include medications, weight loss, or joint replacement surgery.
This document provides information on Paget's disease, including:
- It is a chronic bone disorder characterized by abnormal bone remodeling that can cause bone deformities and fractures.
- The cause is unknown but may involve viruses or genetic factors. It most commonly affects older adults and bones like the pelvis and spine.
- Symptoms can include bone pain, stiffness, fractures, and hearing loss. Lab tests show elevated alkaline phosphatase levels. Imaging like x-rays are used for diagnosis.
- The disease involves abnormal bone breakdown and formation seen on imaging as thickened and misshapen bones. While often asymptomatic, treatment with medications may be used for painful symptoms.
This document discusses osteoarthritis of the knee. It begins by describing the pathologic features of OA including loss of hyaline cartilage and thickening of subchondral bone. It then discusses the mechanisms by which healthy joints are protected and how they fail in OA. Specifically, it outlines the roles of synovial fluid, ligaments, muscles, sensory nerves, and cartilage. Two major components of cartilage, type 2 collagen and aggrecan, are described along with how their degradation by enzymes like MMPs and aggrecanases contributes to OA. Risk factors for OA including age, gender, genetics, previous joint damage, malalignment, obesity, and repetitive activities are covered. Sources of pain in O
Osteoarthritis is the most common form of arthritis. It typically affects older adults over age 45 and is more prevalent in women. Key symptoms include joint pain, stiffness, and loss of mobility. While its exact causes are unknown, risk factors include age, obesity, prior joint injury, and genetics. Treatment focuses on reducing pain and inflammation through medications like acetaminophen, NSAIDs, and viscosupplementation injections. For severe cases not helped by other options, knee replacement surgery may be considered.
2015: Osteoarthritis and Total Joint Replacement-MeyerSDGWEP
Osteoarthritis is a chronic disease with no cure that affects over 27 million Americans. It is the leading cause of disability in the US. While there are no disease modifying treatments, management focuses on non-operative options like exercise, weight loss, and medications. For severe osteoarthritis, total joint arthroplasty provides significant pain relief and functional improvement, but carries risks if patients have uncontrolled medical comorbidities. Referral for joint replacement requires exhausted non-surgical options and optimization of patient health to achieve the best outcomes.
The document discusses various types of arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, infectious arthritis, gout, and myopathies. Osteoarthritis is the most common type in old age and is caused by the progressive erosion of articular cartilage. Rheumatoid arthritis is an autoimmune disorder characterized by chronic synovitis and inflammation of the synovial membrane. Myopathies can be neurogenic due to nerve damage or myopathic due to intrinsic muscle abnormalities. Common myopathies discussed include muscular dystrophies like Duchenne muscular dystrophy, inflammatory myopathies like polymyositis and dermatomyositis, and endocrine/metabolic myopathies
Musculoskeletal injuries (MSI) are injuries or disorders of the muscles, tendons, ligaments, joints, nerves, blood vessels or related soft tissue that are caused or aggravated by work. Common types of MSI include sprains, strains and inflammation. Prevention of MSI is important as they can impact quality of life long-term and result in lost work days. Effective prevention programs should be established at all worksites to minimize MSI risks, educate employees on early signs and symptoms, and implement control measures to reduce risks.
Osteoarthritis is the most common form of arthritis, affecting over 60% of people over 65 years old. It involves the breakdown and eventual loss of cartilage in one or more joints. Risk factors include age, female gender, joint injuries, genetics, and obesity. Symptoms include joint pain, stiffness, swelling, and loss of motion. Treatment focuses on pain management through medications, physical therapy, weight loss, and sometimes joint replacement surgery.
Osteomalacia is a softening of the bones due to defective mineralization. It is caused by vitamin D deficiency or impaired mineral ion absorption. Symptoms include bone pain, muscle weakness, and skeletal deformities like bowed legs. Diagnosis involves blood tests showing low calcium and phosphate levels and high alkaline phosphatase. Treatment depends on the underlying cause but generally involves active vitamin D supplements, calcium, and phosphate as needed.
The document discusses osteoarthritis (OA), the most common type of arthritis. It affects over three million Canadians and causes breakdown of cartilage and bone in joints, resulting in pain, stiffness, and reduced movement. Risk factors include age, family history, excess weight, and previous joint injuries. Symptoms may include joint stiffness, swelling, crepitus, and pain. Treatment focuses on managing pain and improving function through physical activity, heat/cold therapy, joint protection, stress management, healthy eating, medications, and sometimes surgery.
Contents:
Occurrence of Avascular Necrosis
Causes of Avascular Necrosis
Symptoms of Avascular Necrosis
Risk factors of Avascular Necrosis
Bones prone to be Necrosed
Osteoarthritis is characterized by cartilage loss, synovial thickening, and bone changes. It commonly affects the knees, hands, and hips. While age is a risk factor, osteoarthritis has both inflammatory and mechanical components and is influenced by hereditary, constitutional, and environmental factors like obesity and joint injury. Excess weight places mechanical stress on cartilage and adipose tissue may contribute through inflammatory cytokines. Osteoarthritis is now considered a distinct disease entity rather than simply wear and tear of aging.
This document summarizes a presentation on osteoarthritis (OA) phenotypes and risk factors. The presentation discusses evidence that OA may consist of distinct subtypes including generalized vs. joint-specific, secondary vs. primary, painful vs. non-painful, and malaligned vs. neutrally aligned joints. Identifying OA phenotypes is important for developing effective prevention and treatment strategies that may differ between subtypes.
Osteoarthritis risk factors include:
- Age, as it affects 65% of people over 65 and 80% over 80
- Excess weight and obesity, which increase mechanical stress on joints
- Past injuries, especially ligament tears or meniscal damage, which can lead to knee instability
Osteoarthritis is a common type of arthritis that affects joints, causing cartilage breakdown and pain. It most often impacts knees, hips, lower back, fingers, and neck. Risk factors include age, obesity, injury, genetics, and other diseases. Symptoms are joint pain and stiffness. Diagnosis involves physical exams, x-rays, MRI, or other imaging to view cartilage damage. Treatment focuses on reducing pain and improving function through exercise, weight control, medications, joint protection, physical therapy, and sometimes surgery. Managing osteoarthritis requires a combination of lifestyle changes and medical care.
This document provides information on the management of patients with musculoskeletal disorders. It discusses osteoarthritis, including risk factors, clinical manifestations, medical management using pharmacologic and non-pharmacologic therapies, and potential surgical interventions. It also covers pyogenic osteomyelitis and osteoporosis, defining each condition and outlining their treatment objectives, investigations and management approaches.
Osteoarthritis is a progressive degenerative joint disease characterized by the breakdown and eventual loss of articular cartilage in the joints. As cartilage breaks down, bones rub together causing pain, swelling, and loss of motion of the joints. The most common joints affected are weight-bearing joints like the hips, knees, and spine. Risk factors include age, obesity, joint injury, genetics, and repetitive joint stress from certain occupations and sports. The breakdown of cartilage is caused by an imbalance between the normal synthesis and degradation of cartilage components by chondrocytes within the cartilage. This leads to loss of cartilage cushioning between bones and development of bone spurs and cysts at the joint margins over time.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
Osteoarthritis is a common chronic, progressive, degenerative joint disease that affects cartilage and bone within a joint. It most often affects older adults but can also occur in younger people. It is a leading cause of physical disability. Osteoarthritis can be classified as primary, with no known cause, or secondary, due to an underlying condition like injury or obesity. It involves the breakdown and eventual loss of cartilage in one or more joints. Symptoms include pain, stiffness, and reduced mobility. Diagnosis is based on symptoms and confirmed with x-rays showing signs of cartilage loss. Treatment focuses on reducing pain and improving joint function through lifestyle changes, physical therapy, braces, and in some cases surgery.
Osteoarthritis is a type of joint disease that results from the breakdown of cartilage and underlying bone. It commonly affects the hands, feet, spine, and large weight-bearing joints like the hips and knees. The most common symptoms are joint pain, stiffness, and crackling noises. Risk factors include mechanical stress, excess weight, nerve impairment, and hereditary or hormonal conditions. It is diagnosed through x-rays, blood tests, and examination and shows features like bone spurs, cysts, and cartilage loss.
Structural Targets for Prevention of Post Traumatic OAOARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
This document provides an overview of osteoarthritis of the knee, including definition, risk factors, clinical features, diagnosis, treatment options, and surgical considerations. It defines osteoarthritis as cartilage failure induced by genetic and biomechanical factors. Risk factors include age, obesity, injury history. Clinical diagnosis is based on symptoms of pain and stiffness, physical exam findings of crepitus and limited range of motion. Treatment includes weight loss, exercise, braces, medications like acetaminophen, NSAIDs, and injections. Surgery such as arthroscopic debridement or joint replacement may be considered for advanced cases.
Osteoarthritis and rheumatoid arthritis are chronic joint disorders. Osteoarthritis involves the progressive breakdown of articular cartilage in a joint. It is associated with aging and risk factors like obesity, joint injury, and genetics. Rheumatoid arthritis is an autoimmune disease where the immune system attacks the joints, causing pain, stiffness, and swelling. It can eventually damage cartilage and bone within joints and may affect other organs. Both diseases are diagnosed based on symptoms, physical exam, x-rays, and blood tests. Treatment focuses on reducing pain and inflammation, maintaining joint mobility, and may include medications, weight loss, or joint replacement surgery.
This document provides information on Paget's disease, including:
- It is a chronic bone disorder characterized by abnormal bone remodeling that can cause bone deformities and fractures.
- The cause is unknown but may involve viruses or genetic factors. It most commonly affects older adults and bones like the pelvis and spine.
- Symptoms can include bone pain, stiffness, fractures, and hearing loss. Lab tests show elevated alkaline phosphatase levels. Imaging like x-rays are used for diagnosis.
- The disease involves abnormal bone breakdown and formation seen on imaging as thickened and misshapen bones. While often asymptomatic, treatment with medications may be used for painful symptoms.
This document discusses osteoarthritis of the knee. It begins by describing the pathologic features of OA including loss of hyaline cartilage and thickening of subchondral bone. It then discusses the mechanisms by which healthy joints are protected and how they fail in OA. Specifically, it outlines the roles of synovial fluid, ligaments, muscles, sensory nerves, and cartilage. Two major components of cartilage, type 2 collagen and aggrecan, are described along with how their degradation by enzymes like MMPs and aggrecanases contributes to OA. Risk factors for OA including age, gender, genetics, previous joint damage, malalignment, obesity, and repetitive activities are covered. Sources of pain in O
Osteoarthritis is the most common form of arthritis. It typically affects older adults over age 45 and is more prevalent in women. Key symptoms include joint pain, stiffness, and loss of mobility. While its exact causes are unknown, risk factors include age, obesity, prior joint injury, and genetics. Treatment focuses on reducing pain and inflammation through medications like acetaminophen, NSAIDs, and viscosupplementation injections. For severe cases not helped by other options, knee replacement surgery may be considered.
2015: Osteoarthritis and Total Joint Replacement-MeyerSDGWEP
Osteoarthritis is a chronic disease with no cure that affects over 27 million Americans. It is the leading cause of disability in the US. While there are no disease modifying treatments, management focuses on non-operative options like exercise, weight loss, and medications. For severe osteoarthritis, total joint arthroplasty provides significant pain relief and functional improvement, but carries risks if patients have uncontrolled medical comorbidities. Referral for joint replacement requires exhausted non-surgical options and optimization of patient health to achieve the best outcomes.
The document discusses various types of arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, infectious arthritis, gout, and myopathies. Osteoarthritis is the most common type in old age and is caused by the progressive erosion of articular cartilage. Rheumatoid arthritis is an autoimmune disorder characterized by chronic synovitis and inflammation of the synovial membrane. Myopathies can be neurogenic due to nerve damage or myopathic due to intrinsic muscle abnormalities. Common myopathies discussed include muscular dystrophies like Duchenne muscular dystrophy, inflammatory myopathies like polymyositis and dermatomyositis, and endocrine/metabolic myopathies
Musculoskeletal injuries (MSI) are injuries or disorders of the muscles, tendons, ligaments, joints, nerves, blood vessels or related soft tissue that are caused or aggravated by work. Common types of MSI include sprains, strains and inflammation. Prevention of MSI is important as they can impact quality of life long-term and result in lost work days. Effective prevention programs should be established at all worksites to minimize MSI risks, educate employees on early signs and symptoms, and implement control measures to reduce risks.
Osteoarthritis is the most common form of arthritis, affecting over 60% of people over 65 years old. It involves the breakdown and eventual loss of cartilage in one or more joints. Risk factors include age, female gender, joint injuries, genetics, and obesity. Symptoms include joint pain, stiffness, swelling, and loss of motion. Treatment focuses on pain management through medications, physical therapy, weight loss, and sometimes joint replacement surgery.
Osteomalacia is a softening of the bones due to defective mineralization. It is caused by vitamin D deficiency or impaired mineral ion absorption. Symptoms include bone pain, muscle weakness, and skeletal deformities like bowed legs. Diagnosis involves blood tests showing low calcium and phosphate levels and high alkaline phosphatase. Treatment depends on the underlying cause but generally involves active vitamin D supplements, calcium, and phosphate as needed.
The document discusses osteoarthritis (OA), the most common type of arthritis. It affects over three million Canadians and causes breakdown of cartilage and bone in joints, resulting in pain, stiffness, and reduced movement. Risk factors include age, family history, excess weight, and previous joint injuries. Symptoms may include joint stiffness, swelling, crepitus, and pain. Treatment focuses on managing pain and improving function through physical activity, heat/cold therapy, joint protection, stress management, healthy eating, medications, and sometimes surgery.
Contents:
Occurrence of Avascular Necrosis
Causes of Avascular Necrosis
Symptoms of Avascular Necrosis
Risk factors of Avascular Necrosis
Bones prone to be Necrosed
Hinduja hospital conducts regular webinars and tweetinars for online users where they can seek advice from expert doctors of hinduja hospital for free. Above is the webinar conducted by hinduja hospital on Osteoporosis where issues like osteoporosis symptoms, osteoporosis prevention, osteoporosis treatment were discussed successfully by Spine Consultant, Dr. Uday Pawar.
To know more about such upcoming webinars and tweetinars from hinduja hospital, visit http://www.hindujahospital.com/communityportal/
This document provides an overview of osteosarcoma, including its definition, epidemiology, pathogenesis, clinical presentation, evaluation, classification, investigations, treatment, and prognosis. Some key points are:
- Osteosarcoma is a highly malignant bone tumor arising from bone-forming cells. It produces malignant bone and most commonly affects adolescents and young adults. The most common sites are the distal femur, proximal tibia, and proximal humerus.
- Evaluation involves imaging like X-rays, CT, MRI and bone scans. Biopsy is needed to confirm diagnosis. Staging uses the Enneking system. Treatment typically involves neoadjuvant chemotherapy, surgical resection with wide margins, and reconstruction with
Highly malignant tumor of mesenchymal origin.Spindle shaped cells that produce osteoid.2nd most common primary malignant bone tumor after MM.Incidence – 1 to 3 per million per year
Treated by chemo,amputation or rotationplasty
Osteoporosis is a disease where bones become brittle and weak, increasing the risk of fractures. It occurs when the body loses more bone than it forms, reducing bone density. Common symptoms include back pain, loss of height, and fractures of the spine, wrists and hips. Risk factors include age, gender, family history, smoking, excessive alcohol, low calcium intake, and medical conditions or medications that reduce bone density. Diagnosis involves tests like DXA scans to measure bone mineral density. Treatment focuses on lifestyle changes, medications, and fall prevention to reduce fractures and complications.
El documento trata sobre la osteoporosis. Explica que es una enfermedad ósea caracterizada por la pérdida de masa ósea y la fragilidad de los huesos, lo que aumenta el riesgo de fracturas. Se detalla que es causada por un desequilibrio entre la formación y la resorción ósea, con predominio de esta última. También se describen los factores de riesgo, el diagnóstico mediante densitometría ósea y las opciones de tratamiento farmacológico y de estilo de vida.
Osteoarthritis is a chronic degenerative disorder of synovial joints in which there is progressive softening and erosion/disintegration of the articular cartilage. In the presentation, I will deal in detail about the condition in every dimension with the most recent evidence.
Osteoarthritis is a chronic condition that causes breakdown of cartilage in joints, resulting in pain, swelling, and loss of motion. It most commonly affects weight-bearing joints like the hips and knees. Risk factors include age, genetics, excess weight, and joint injuries. Osteoarthritis can profoundly impact one's physical and mental health by limiting mobility and social activities. Treatment focuses on reducing pain and inflammation through medications, exercise, weight loss, and sometimes surgery like joint replacement for severe cases.
This document provides information about osteoarthritis (OA), including its definition, causes, risk factors, and effects on joints. OA is a progressive disease involving the breakdown of cartilage in joints. Key risk factors include age, obesity, joint injury, genetics, and certain occupations. As cartilage breaks down, bone rubs against bone, causing pain, swelling, and loss of motion in joints. Over time, joints may lose their normal shape as bone spurs develop.
Studying relation between sitting position and knee osteoarthritiiosrjce
Osteoarthritis (OA) of the knee is the most common form of arthritis and leads to more activity
limitations (e.g., disability in walking and stair climbing) than any other disease, especially in the elderly. The
aim of this study was to clarify the relationship between the sitting position and knee osteoarthritis. The study
involved fat males of knee pain and clinical diagnosis of early knee osteoarthritis this research is applied and
the research method is "descriptive-correlative". In order to collecting data was used questionnaire tool. Also,
in order to analyzing data was used statistical method such as Pierson coefficient and Chi-squared test. Data is
analyzed from both descriptive and inferential statistics. Descriptive statistics and graphs on the table will
describe the characteristics of the study sample. The researcher to analyze the hypotheses used Chi-square
method. The statistical society is Osteoarthritis disease males.
Osteoarthritis is a progressive degenerative joint disease characterized by the breakdown of cartilage in joints. It involves the inflammation of one or more joints and the gradual loss of cartilage over time. As cartilage breaks down, the bones underneath rub together causing pain, swelling, and loss of motion in the joints. Risk factors include age, obesity, joint injury, genetics, and repetitive stress on joints. The disease process occurs as cartilage is damaged faster than it can be repaired, leading to further breakdown and loss of cartilage cushioning between bones.
Cervical spondylosis is a degenerative condition affecting the bones and joints in the neck. It causes pain, stiffness, and weakness and can compress nerves leading to sensory and motor problems. Symptoms range from mild neck pain to major dysfunction. While it mainly affects older adults, injuries or occupations involving heavy lifting or straining of the neck can also trigger it. Treatment focuses on relieving pain and addressing weakness, sensory loss, and other symptoms through analgesics, cervical collars, physiotherapy, surgery if needed, and encouraging patients to seek medical help. Healthcare assistants should explain cervical spondylosis to patients and ensure any problems are referred to doctors.
Osteoarthritis is a common degenerative joint disease characterized by cartilage breakdown and new bone growth. It results from mechanical and biological processes disrupting cartilage and bone homeostasis. Risk factors include age, sex, joint injuries, bone deformities, obesity, and other bone/joint diseases. Symptoms include joint pain, tenderness, stiffness, and loss of flexibility. Diagnosis involves x-rays showing bone spurs and joint space narrowing. Treatment includes weight loss, exercises, braces, medications, injections, and sometimes surgery like joint replacement.
Osteoarthritis is a common degenerative joint disease characterized by cartilage breakdown and new bone growth. It results from mechanical and biological processes disrupting cartilage and bone homeostasis. Risk factors include age, sex, genetics, injury, obesity, and other bone/joint conditions. Symptoms are joint pain, stiffness, swelling, and loss of flexibility. Diagnosis involves x-rays showing bone spurs and joint space narrowing. Treatment includes weight loss, exercises, braces, medications, injections, and sometimes surgery like joint replacement.
Osteoarthritis is a slowly progressive degenerative disease leading to gradual loss of articular cartilage. It affects not only cartilage but other joint tissues as well, including bone, ligaments, capsules, and synovial membrane. Risk factors include age, obesity, joint injury, genetics, and occupational factors. Symptoms include joint pain, stiffness, crepitus, and deformity. Diagnosis is based on clinical features and confirmed with x-rays showing bone spurs and joint space narrowing. Treatment involves lifestyle changes, medications for pain/inflammation, injections, and surgery for advanced cases.
Presentation1.pptx, radiological imaging of osteoarthritis.Abdellah Nazeer
Radiological imaging of osteoarthritis was discussed. Osteoarthritis is the most common form of arthritis and involves the breakdown of cartilage in joints. Common symptoms include pain, stiffness, and loss of mobility. Diagnosis is typically made based on x-ray findings of joint space narrowing, bone spurs, and bone sclerosis. MRI can also detect cartilage damage and bone marrow lesions. The most commonly affected joints are the hips, knees, spine, hands and feet. Treatment focuses on reducing pain and inflammation.
This document summarizes the anatomy and common injuries of the knee joint. It begins by describing the tibiofemoral and patellofemoral joints. It then discusses the bones that make up the knee, including the femur, patella, and tibia. Next, it outlines the major muscles that act on the knee, including the quadriceps, hamstrings, adductors, and sartorius. It also mentions the iliotibial band. The document concludes by briefly discussing the ligaments of the knee - ACL, PCL, MCL, LCL - and common knee injuries such as meniscal tears and ligament sprains.
Osteoarthritis and total joint replacement.ppt (1)Ali Ismail
Osteoarthritis and Total Joint Replacement: Risk Factors, Prevention, and Treatment, and the Effects on Sensory Mechanisms Encountered by Osteoarthritic Total Joint Replacement Patients. This document discusses osteoarthritis, including risk factors like age and obesity, common symptoms like joint pain and stiffness, diagnostic methods like x-rays, and treatment options like physical therapy, medications, joint replacements and resurfacing. It also covers changes to sensory systems like vision and balance that can increase fall risks for osteoarthritic patients and accelerate the need for joint replacement surgery.
- Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the spine and sacroiliac joints, causing back pain and spinal stiffness. It is associated with the HLA-B27 gene and sometimes follows bacterial infections.
- Symptoms include limited spinal mobility, buttocks and hip pain, and inflammation of tendon attachments or entire fingers. It typically presents in individuals younger than 40 and is more common in men.
- Treatment involves exercise, medications like NSAIDs and TNF inhibitors, and surgery for joint replacement or spinal issues. The goals are to reduce pain, improve mobility, and prevent complications.
Osteoarthritis with mechanism, pathology and treatmentarun chand roby
Osteoarthritis is a common degenerative joint disease characterized by cartilage breakdown and new bone growth. It results from mechanical and biological imbalances in cartilage and subchondral bone. Risk factors include older age, female sex, joint deformities, injuries, obesity, and other bone/joint diseases. Symptoms include joint pain, tenderness, stiffness, loss of flexibility, and bone spurs. Diagnosis involves x-rays showing cartilage loss, bone spurs, and bone changes. Treatment includes weight loss, exercises, medications, injections, and sometimes surgery like joint replacement.
Presentation1.pptx, radiological imaging of paget disease.Abdellah Nazeer
Paget's disease is a chronic bone disorder characterized by abnormal bone remodeling. It commonly affects the pelvis, spine and skull. Radiography is often used to evaluate Paget's disease and detect characteristic features like thickened bone and osteolytic lesions. While some cases are asymptomatic, complications can include fractures, osteoarthritis, nerve entrapment and rare neoplastic transformations. MRI and bone scintigraphy provide additional information about disease activity and complications.
The document discusses osteoarthritis of the knee, including:
1. Risk factors for osteoarthritis like age, gender, genetics, obesity, and joint injuries.
2. Clinical features like pain, stiffness, swelling, crepitus, and deformity.
3. Diagnostic tools like x-rays, MRI, CT, and arthroscopy that can assess cartilage damage and bone changes.
4. Treatment approaches including medications, physical therapy, weight loss, bracing, injections, and surgeries like arthroscopy, osteotomies, knee replacements, and arthrodesis.
Osteoporosis is the most common metabolic bone disorder characterized by low bone mass and deterioration of bone tissue leading to increased bone fragility and risk of fractures. It is a major cause of morbidity and mortality. Diagnostic imaging plays an important role in identifying osteoporosis and quantifying bone mineral density (BMD). Conventional radiography can detect osteoporosis once 30% of bone is lost but is not quantitative. DXA is the gold standard for measuring BMD and diagnosing osteoporosis based on T-scores. Other modalities like quantitative CT and MRI allow assessment of trabecular and cortical bone separately but have limitations of availability and radiation dose.
This document provides a comprehensive overview of osteoarthritis, including its definition, causes, risk factors, signs and symptoms, diagnosis, treatment options, self-care strategies, and the role of yoga and complementary therapies. It describes how osteoarthritis results from the breakdown of cartilage in joints, most often affecting the hands, spine, knees and hips. Risk factors include age, genetics, injury and obesity. Treatments include medications, exercise, weight control, and in some cases surgery.
Arthritis and arthroplasty- dr. Mahmoud Abdel KareemAhmed-shedeed
This document provides information about osteoarthritis (OA), including its definition, prevalence, risk factors, pathology, diagnosis, natural history, differential diagnosis, and treatment. It notes that OA is the most common form of arthritis, affecting over 20 million people in the US. Risk factors include age, obesity, family history, and previous joint injury or disorder. Diagnosis is typically based on symptoms like pain and stiffness, physical exam findings, and x-ray evidence of cartilage loss, bone spurs, and bone changes. Treatment includes conservative options like medications, exercise, and weight loss, as well as intra-articular injections or surgery for advanced cases.
Lorem Ipsum is simply dummy text used in the printing and typesetting industry. It has been the standard dummy text since the 1500s, when an unknown printer scrambled pieces of text to demonstrate different typefaces.
The document defines and discusses different types of computer networks. It begins by defining a computer network as an interconnection of two or more computers that allows them to communicate and share resources. It then discusses the basic components of a network like computers, cables, network cards, and software. The document classifies networks based on their geographical area into local area networks (LANs), wide area networks (WANs), personal area networks (PANs), and metropolitan area networks (MANs). It provides examples of each type of network and how they differ based on their size and connection method.
The document is a presentation gig advertisement that provides information about presentation and infographic design services. The services include creating presentations in PowerPoint, Keynote and Photoshop with high quality graphics, illustrations, and animations. The designer offers unlimited revisions and provides editable files in various formats including PPTX, KEY, PSD and PDF. They guarantee 100% satisfaction and offer a money back guarantee. Their portfolio can be viewed on their blog and contact information is provided.
The document discusses improving information sharing between government agencies and private industry facilities regarding cybersecurity threats and compliance. It notes there are over 12,800 private facilities and 30+ government agencies involved but information often flows sporadically without coordination between the Industrial Security Representatives and Cybersecurity and Infrastructure Security Agency. The process also lacks understanding of what specific assets need protection at each facility and the potential consequences of losing those assets.
This document provides leadership lessons from Fred Shae. It is summarized in 3 sentences:
The document discusses 4 keys to extraordinary leadership according to Fred Shae: 1) leadership makes a difference through relationships, 2) relationships are built on continually creating value for others, 3) leaders must regularly reinvent themselves, and 4) bringing people together to work for a common purpose. It provides examples and stories about Fred Shae to illustrate these principles of leadership.
Hi, I am a Freelancer .You can contact with me for your presentation professionally designed and with unlimited revisions in Just $5.
Here is my gig address:
https://www.fiverr.com/awadood
For Social Media Contact with me:
https://web.facebook.com/a03127809853
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
3. Incidence
Age and sex-standardized incidence rates of symptomatic radiographic OA in the
in adults aged ≥20 years and older
Hand OA = 100 per 100,000 person years. Knee OA = 240 per 100,000 person years
Hip OA = 88 per 100,000 person years.
4. Because of the aging of our society and the obesity
epidemic, the burden of OA will continue to increase
over the next 20 years
5. 1.Idiopathic
Localized
Medial Compartment Lateral Compartment
Patellofemoral Compartment
(e.g., chondromalacia)
Eccentric (superior) Concentric (axial, medial)
Diffuse (Coxae senilis)
Apophyseal Intervertebral(disk)
Spondylosis (osteophytes)
Ligamentous (hyperostosis
[Forestier disease or DISH])
Generalized: include three or more
areas listed above (Kellgren-Moore)
Hands (e.g.,Heberden and Bouchard nodes [nodal], erosive
interphalangeal arthritis [nonnodal]): Scaphometal,
scaphotrapezial )
Feet (e.g.,Hallux valgus, hallux rigidus, contracted toes
[hammer/cock-up toes]):talonavicular
Knee
Hip
Spine (particularly cervical and lumber
Other single sites (e.g., shoulder temporomandibular,
sacroiliac, ankle,wrist, acromioclavicular)
Small (Peripheral and Spine)
Large (Central and Spine)
Mixed (Peripheral and Central)
6. 2.Secondary
Posttraumatic
Congenital or
developmental diseases
Localized
Hip Diseases (e.g.,
Legg-Calve-Perthes,
congential hip
dislocation, slipped
capital femoral
epiphysis, shallow
acetabulum)
Mechanical and Local
Factors (e.g., obesity
[?], unequal lower
extremity)
Generalized
Bone dysplasias (e.g
epiphyseal dysplasia,
spondyloapophyseal
dysplasia)
Metabolic diseases
(e.g., hemochromatosis,
ochronosis, Gaucher
disease,
hemoglobinopathy,
Ehlers-Danlos-Danlos
syndrome)
Calcium deposition
disease
Calcium
pyrophosphate
deposition disease
Apatite arthropathy
Destructive
arthropathy (shoulder,
knee)
Other bones and joint
disorder (e.g.,
avascular necrosis,
rheumatoid arthritis )
Other Deseases
Endocrine diseases
(e.g., diabetes mellitus,
acromegaly,
hypothyroidism,
hyperparathyroidism
necrosis, rheumato)
Neuropathic
arthropathy (Charcot
joints)
Miscellaneous (e.g.,
frostbite, Kashin-Beck
disease, caisson disease)
7. OA can be defined pathologically, radiographically, or
clinically,
8. American College of Rheumatology criteria for osteoarthritis
(OA) of the hand, hip, and knee
9. Item Required for presence of OA
Hand(Clinical)
Hand pain, aching, or stiffness
for most days of prior month
(1,2,3,4 or 1,2,3,5)
Hard tissue enlargement of
> 2 of 10 selected hand joints
MCP swelling in < 2 joints.
Hard tissue enlargement of
> DIP joints
Deformity of >1 of 10
selected hand joints.
Hip(Clinical &
Radiographic)
Hip pain for most days of
the prior month. (1,2,3 or
1,2,4 or 1,3,4)
ESR <20 mm / hr
(laboratory)
Radiographic femoral and /
or acetabular osteophytes.
Radiographic hip joint space
narrowing
Knee(Clinical)
Knee pain for most days of
prior month
Crepitus on active joint
motion
Morning stiffness <30min in
duration
Age >38yr
Bony enlargement of the
knee on examination
Knee (Clinical &
radiographic)
Knee pain for most days of
prior month
Osteophytes at joint margins
(radiograph)
Synovial fluid typical of OA
(laboratory)
Age >40yr
Morning Stiffness <30 min
in duration
Crepitus on active joint
motion
11. Grade Classification Description
0 Normal No features of osteoarthritis
1 Doubtful Minute osteophyte, doubtful signification
2 Minimal Definite osteophyte, unimpaired joint space
3 Moderate Moderate diminution of joint space
4 Severe Joint space greatly impaired with sclerosis of subchondral bone
Kellgren-Lawrence radiographic grading system
for osteoarthritis
Adapted from Kellgren JH, Lawrence JS, editors. The epidemiology of chronic rheumatism, atlas of standard radiographs.
Oxford: Blackwell Scientific 1963.
12. Example of semiquantative. Radiographics assessment with use of the Kellgren-Lawrence and Osteoarthritis Research-Society International (OARSI) grading scheme. (a)
Kellgren-Lawrence grade 3. No lateral femoral and tibial osteophytes are seen (OARSI grade 0). A medial femoral osteophyte OARSI 1 (white arrow), a medial tibial
osteophyte OARSI grade 2 (White arrowhead). Lateral tibiofemoral joint space width OARSI grade 0, and medial tibiofemoral joint space narrowing OARSI grade 2
(black arrows) are depicted.(b) Kellgren-Lawrence grade 2. A lateral femoral osteophyte OARSI grade 2 (white arrow), a lateral tibial Osteophyte OARSI grade 2 (white
arrowhead), a medial femoral osteophyte OARSI grade 3 (black arrowhead), a normal lateral tibiofemoral joint space width OARSI grade 0, and medial tibiofemoral joint
space width OARSI grade 1 (gray arrow) are shown.
13. Lack of perfect congruence between radiographic
findings of OA and clinical symptoms. Up to 60% of
individuals with radiographic knee OA may not
complain of pain.
14. Sometimes individuals may curtail symptom-inducing
activities and that even “asymptomatic” radiographic
OA is not without consequence.
15. Higher mortality associated with increasing age, male sex, walking disability, and self-
reported comorbidities (diabetes, cancer, cardiovascular disease) but not with joint
affected, previous joint replacement, obesity, nonsteroidal antiinflammatory drug use,
depression, or baseline hip or knee pain.
Reduced physical activity and a chronic inflammatory state in OA patients may contribute
and should be aggressively managed
16. Overview: Primary OA
DIP Joints
PIP Joints
CMC Joints
AC joints
Hip Joints
Knee Joints
1st MTP joints
Facet / apophyseal joints of the C- and L-spine
18. Risk Factors for
osteoarthrits
Increasing
age (All sites)
Trauma, and some
occupation involving
repetive activities
(Specific sites)
Obesity (most sites, but
more marked for the
knee than other joints)
Genetic
predisposition
(All sites)
Race of ethnicity
(Variable at
different joint sites)
Female sex or gender
(Some sites
particularly knee and
hand)
19. A framework for understanding systemic and local
risk factors for osteoarthritis
Systematic factors affecting joint
vulnearability
1.Age
2.Female Gender
3.Race
4.Genetic susceptibility
5.Nutritional factors
Susceptibility to osteoarthritis
Use (loading) factors acting on joints:
1. Obesity
2. Injurius physical
3.Activities
Osteoarthritis or its progression
Intrinsic joint vulnerabilities (Local
enviroment):
1. Previous damage (e.g., meniscectomy; ACL tear)
2.Bridging muscle weakness
3. Cartilage not responsive
4.Malalignment
5.Proprioceptive deficiencies
20. Person with OA in one joint is at high risk of getting it in others, even other joints distant
from the first.
Systemic risk factors
21. With age, chondrocytes, which do not replicate throughout life, become senescent and
become less responsive to regulatory growth factors in the cartilage matrix
environment,and the cartilage matrix itself changes in ways that make it more vulnerable
to injury.
The local joint environment also changes with age in ways that make the joint susceptible
to damage. With age, muscles become weaker and less well conditioned. Reaction times
slow so that incipient injury to a joint from an oncoming weight-bearing load may not be
buffered or shock absorbed as competently in an older joint as in a younger one
22. Even if it does not have direct effects on joint structure, vitamin D deficiency may have
indirect effects on joint health by lowering the threshold for joint pain. Vitamin D
deficiency has been linked with generalized pain, and vitamin D deficiency may impair
muscle function so that rehabilitation is difficult
23. Some of the changes in local joint environment may be more
prominent in women (e.g., loss in strength and conditioning), and
hormone-related changes that occur in postmenopausal women may
increase disease risk, although the data on estrogen loss and its
relation to the development of OA are mixed
24. Factors in the local joint environment
In all joints, cartilage and other structures in the joint are designed to bear a certain amount
of stress (force per unit area) during loading and joint use. When the direction of the
transarticular load changes or when the joint becomes misshapen, altering loading patterns
inside the joint, focal loads within the joint transcend physiologic parameters and joint
damage can occur
25. In some joints such as the ankle and the wrist, which are only rarely affected by OA, most
disease is caused by major joint injury
In joints more commonly affected by OA such as the knee and hip, major joint injuries,
perhaps even unrecognized ones, also are likely to be major causes of disease
In the knees, the common joint injuries with important effects on subsequent joint function
and disease are anterior cruciate ligament (ACL) tears and meniscal tears.
Factors in the local joint environment
27. Hip dysplasia in which there is an underdevelopment of the acetabulum leading to
undercoverage of the femur and excess focal stress where the edge of the acetabulum
contacts the femur.
Others include a nonspherical femoral head or an acetabulum that extends too far around
the femoral head; both of these latter problems can cause femoroacetabular impingement
(FAI)
Hip osteoarthritis and abnormalities of joint shape
28. OA occurs when that loading occurs in an environment in which the joint is already
injured or impaired or in which the loading is so excessive or injurious that even a normal,
well-functioning joint cannot tolerate it without injury
Risk factors relating to loading of the joint
29. Obesity has a far greater effect on knee OA than it has been shown to have on hand OA,
which suggests that most of the effect of obesity can be explained by its effect in
producing excess load
For hip OA the relation of obesity is less strong and less clear. The development of new-
onset symptomatic OA is increased in persons who are obese, as is the risk of developing
bilateral radiographic disease, although there is no significant or consistent relationship
between obesity and the development of unilateral OA of the hip.
Obesity
30. Physical activity does not consistently increase the risk of OA
Risk Factors
First, as noted earlier, elite marathon runners—those on Olympic teams and who run professionally—are
at a high risk of developing knee and hip OA at a relatively early adult age (in their 30s or 40s).
Second, those whose jobs require manual labor with repetitive activities that load a specific joint
excessively and repeatedly tend to get OA in the overused joint (e.g., cotton pickers in hand joints; miners
in backs and knees), which suggests that even normal joints can develop OA if these joints are forced to do
the same laboring task for hours every day and many weeks each year over many years.
Lastly, marathon runners who have already had meniscal tears are at high risk of advanced OA if they
continue to run
Physical activity: injurious or protective?
31. High bone mineral density increases the risk of knee and hip OA independently of other
factors such as obesity and strength
Unclear reason
The peculiar case of bone mineral density: is it
systemic or local?
34. The presence or absence of an obvious cause (Primary or Secondary OA).
The distribution between joints and number of joints affected (localized or generalized OA).
The amount of bone formation around the joints, or, conversely or bone attrition (hypertrophic or atrophic OA),
and the related presence or absence of diffuse idiopathic skeletal hyperostosis
The presence of absence of overt inflammation (inflammatory OA)
The presence or absence of chondrocalcinosis (pyrophosphate arthropathy) or of basic calcium phosphate crystal
deposition (apatite-associated arthropathy).
The rate of progression (rapidly progressive osteoarthritis).
The main factors that have been considered as
indicative of possible subsets have included
1
2
3
4
5
6
35. Pain of OA changes during the day and has been demonstrated to vary by 20% within a
given week and from week to week.Pain in OA is also influenced by pain at other sites and
by patient adaptation and avoidance strategies, and it is inextricable from function.The
pain of OA is associated with poor sleep, fatigue, changes in mood, and impaired quality
of life.
Joint pain is often referred distally; for example, hip pain may be referred into the thigh or
knee
36. Anatomic Site Mechanism
Cartilage (defective or lost)
Synovial: inflammation induced by cartilage “char” fragments, cartilage crystal
shedding, cartialage release of cytokines (e.g., interleukin-1), enzymes (e.g.,
metalloproteinases)
Subchondral bone: Mechanical stress (see below)
Instability: Stress on capsule.
Menisci Tear or degeneration: stretch at insertion to the joint capsule, catch between surfaces.
Synovial cavity Stretch of joint capsule, transport of inflammatory mediators between synovium and
cartilage.
Synovium Inflammation, hypertrophy
Subchondral bone Ischemia with increased subchondral pressure, decreased, oxygen tension, and
increased pH.
Avascular necrosis.
Regeneration or repair of infarcted bone.
Osteophytes Periosteal elevation
Neural impingement.
Table: Relationship between anatomic site and possible physiologic pain in osteoarthritis
37. Anatomic Site Mechanism
Osteophytes Periosteal elevation
Neural impingement
Joint capsule Stretch from joint distention.
Stress at insertion to periosteal and bone.
Bursae Inflammation, with or without classification
Muscle Spasm, contracture
Nocturnal myoclonus
Central nervous
system
Depression, anxiety, fibromyalgia, non-restorative sleep.
General Ethnic and cultural factors, coping skills, prior pain experience, abuse
Altered function placing stress on other areas of the musculoskeletal system
Table: Relationship between anatomic site and possible physiologic pain in osteoarthritis
38. Pain can be measured through standardized testing.
For the hip or knee, the Western Ontario McMaster Universities (WOMAC) Osteoarthritis Index quantifies pain,
stiffness, and function in separate subscales.
http://www.rheumatology.org/I-Am-A/Rheumatologist/Research/Clinician-Researchers/Western-Ontario-
McMaster-Universities-Osteoarthritis-Index-WOMAC
The algofunctional index of Lequesne measures hip or knee pain and function in a single scale.
The WOMAC index has been incorporated into the Hip Dysfunction and Osteoarthritis Outcome Score (HOOS)
and the Knee Dysfunction and Osteoarthritis Outcome Score (KOOS).
Because of the often cyclic nature of OA, an 11-item tool, the Measure of Intermittent and Constant Osteoarthritis
Pain (ICOAP), has been developed.
For the hand, validated scales include the Australian-Canadian Hand Osteoarthritis Index (AUSCAN) and the
Functional Index for Hand Osteoarthritis (FIHOA)
39. Damaged articular cartilage indirectly causes pain due to loss of its structural integrity,
alteration in biomechanics, cartilage debris, and release of inflammatory mediators.
Structural damage to cartilage causes uneven surfaces, which results in a grinding
sensation felt by the patient and crepitus on examination, often accompanied by pain
Damage to articular cartilage
40. Although synovial inflammation is most often less severe than in
the traditional “inflammatory” arthritides (e.g., rheumatoid
arthritis), activation of inflammatory responses always occurs in
OA joints, at both the synoviocyte and chondrocyte level (which
justifies the term osteoarthritis)
41. In cases in which cartilage is fissured and the subchondral bone is exposed, hydroxyapatite
crystals from bone or cartilage may leach or be sheared into the synovial cavity. In
addition, the absence of articular cartilage allows loosening and instability of the joint and
exposure to subchondral bone.
Other loose bodies in the joint, such as “joint mice” or osteochondromatosis, are potential
indirect causes of pain. The disrupted portion of torn menisci can be displaced, stretching
the joint capsule.
42. Synovial fluid can indirectly cause pain by serving as a transport medium, distending the
joint capsule, and/or limiting joint function. In OA the synovial fluid may act as a reservoir
for inflammatory cytokines, cells, and crystals. In addition, excess synovial fluid distends
the joint, which potentially compresses synovial blood vessels and stimulates pressure
receptors in the capsule.25 A distended joint compromises the normal transport of nutrition
and gases by synovial fluid between cartilage and synovium. The residual waste products
linger in the synovial space and perpetuate inflammation.
Role of synovial fluid
43. The synovium contains nerve fibers. These include Aβ (large myelinated
mechanoreceptor), Aδ (large myelinated mechanoreceptor/nociceptor), and C
(small nonmyelinated nociceptor) fibers.20 The latter can release both substance P
and calcitonin gene–related peptide (CGRP). Substance P stimulates both the pain
response and inflammation
44. Osteophytes are the most consistent pathologic and radiographic finding associated with
the presence of pain.31 Osteophytes may cause pain directly by distending the periosteum;
pain can sometimes be elicited by applying pressure over an osteophyte about the knee or
interphalangeal joint of the hand
The pain of ischemic bone is aching and deep seated. In OA, subchondral cysts and
sclerosis are radiographic evidence that localized osteonecrosis has taken place.
45. The joint capsule and periarticular ligaments are stretched by synovial effusions, abnormal
menisci, or instability and may cause pain through mechanoreceptors and nociceptors.
Stress at the ligamentous insertion on the periosteum stimulates nociceptors. When the
periarticular tissues are distorted, the ligaments may be abnormally stressed, which
induces contractures that result in decreasing function and increasing pain from stress at
ligamentous insertions and periarticular muscle spasm.
Damage to meniscus, capsule, and related tissues
46. Muscle spasm is probably a common source of pain
in OA. Muscle spasm may occur in the form of
nocturnal myoclonus, altering sleep patterns and
resulting in fibromyalgia-like symptoms. Muscle
spasm of the lower extremities must be
differentiated from pain related to vascular causes
(e.g., night cramps) or restless leg syndrome and
pain of spinal radicular origin. Joint contractures in
OA can cause pain on stretching of the periarticular
ligaments and muscles.
47. Periarticular bursae may become inflamed and hence be a
source of pain (e.g., anserine bursitis medial and inferior
to the knee). Bursal inflammation is sometimes associated
with calcium formation (e.g., calcific bursitis).
48. Pain is complicated by the presence of coexistent or induced psychological distress, such
as depression
Psychological factors and pain
49. Stiffness may be defined as a sensation of a gelling or tightening of the involved joint that
usually occurs after inactivity, such as in the morning or when rising after sitting for a
prolonged period. The stiffness in OA usually lasts only a few minutes and almost always
less than 30 minutes, in contrast to the diffuse stiffness of rheumatoid arthritis. Also, the
stiffness in OA is usually confined to the symptomatic joints.
Stiffness
50. Impaired function of a weight-bearing joint places stress on the
contralateral weight-bearing joints. It is not uncommon for the patient
with impaired right knee function (perhaps with pain) to have
difficulty with the left hip and vice versa.
51. Patients may complain of enlargement of the joints of the hand or knee. They
may also complain of increasing deformity of the knees, such as knocked
(valgus) or bowed (varus) knees. There may be a click or grinding sensation
with joint motion, and this grinding may be associated with pain. In the knee,
instability is often associated with a feeling that the knee is “giving out.”
52. Inactivity secondary to pain may lead to significant weakness
and can be compounded by periarticular muscle atrophy.
54. Gait
OA of the hip or knee frequently is associated with significant changes in the periarticular
muscles, often with atrophy and weakness. Reduced muscle strength is compounded by
reduced proprioception
55. Tenderness
There may be tenderness of soft tissues (e.g., synovium, capsule, bursae, and
periarticular muscles) or periosteum at the insertion of capsule or ligaments.
56. There may be enlargement of the joint from synovitis, synovial effusion, or bony
enlargement. Effusions are usually cool or slightly warm to palpation. Effusion of the
distal interphalangeal (DIP) joint may present as a cystic herniation ; aspiration often
reveals a jelly like material reminiscent of a ganglion cyst. Swelling of the joint from an
effusion frequently leads to loss of extension.
Joint swelling
57. Grinding, crunching, or cracking may be heard over a joint with OA. Crepitus is caused by
movement of uneven surfaces across each other and is best demonstrated with active
motion of the joint. This contrasts with the benign “cracking” of the proximal
interphalangeal (PIP) joints that occurs when smooth cartilage surfaces are separated,
which creates a vacuum sound with release of nitrogen gas.
Crepitus
58. There may be loss of function with reduced motion as a result of pain, synovitis/effusion,
or periarticular soft tissue contractures. When motion of a weight-bearing joint is limited,
additional stress is placed on ipsilateral and contralateral weight-bearing joints
Limitation of motion
59. Deformity may be present in any of the peripheral joints with OA. However, it is most
notable in the interphalangeal joints of the hands with enlargement and subluxation, in the
first CMC joint, in the knees (varus/valgus deformity), or in the hips (shortened
extremity). Deformity may be associated with joint fusion or instability.
Deformity
60. Range-of-motion examination may reveal instability in various planes of motion. For
example, instability of the knee may be demonstrated in the anteroposterior planes
(cruciate ligament laxity or deficiency) or in the mediolateral planes (loss of meniscus,
collateral ligament laxity, loss of medial compartment bony stock).
Instability
61. OA of the knees and hips occurs in a monarticular or oligoarticular distribution. OA of the
hands and OA of the feet are generally present in the same individual to varying degrees.
There is a subgroup of patients who have OA in three or more joint groups, which is
known as generalized OA.
Patterns of joint involvement
62. Shoulder pain is sometimes related to glenohumeral OA. Pain is typically aching and is
associated with extremes of motion or occurs after activity of the shoulder. OA of the
shoulder usually coexists with, and is difficult to differentiate from, other abnormalities of
the shoulder (e.g., rotator cuff abnormalities, adhesive capsulitis, labrum, and bursitis).
Shoulder
63. A peculiar destructive arthropathy (Milwaukee shoulder) is associated with
persistent shoulder pain, large synovial effusions, and demonstration of a variety
of synovial fluid calcium crystals
Acromioclavicular joint OA can produce pain that can be aggravated by weight
bearing or other stressful activities. Painless enlargement of the acromioclavicular
and sternoclavicular joints is commonly associated with reduced shoulder motion.
64.
65. Classification of hand OA into nodal (noninflammatory) OA and erosive interphalangeal
(inflammatory) OA.
Erosive inflammatory osteoarthritis is localized to the DIP, PIP, and first CMC joints of
the hands. It causes more pain, tenderness, and soft tissue swelling than does typical
nodal osteoarthritis. Patients with this variant experience rapid loss of motion from
joint destruction that may lead to bony ankylosis. This localized form of
osteoarthritis is the most common cause of an asymmetric non-infl ammatory
polyarthropathy.
Hand OA
66. DIP joints are typically involved, with slow bony enlargement over a period of years
(Heberden nodes)
On occasion, the evolution of interphalangeal OA may be indistinguishable from early-
onset rheumatoid arthritis or psoriatic arthritis.
67. Clinical photograph of a patient with nodal,
generalized osteoarthritis showing the typical
swellings of the distal interphalangeal joints
(Heberden’s nodes) and of the proximal
interphalangeal joints (Bouchard’s nodes),as
well as squaring of the thumb base due to OA
and subluxation of the carpometacarpal joint.
(From Women’s Health Service, University of
Maryland Medical School, with permission).
69. Examination demonstrates hard tissue (bony) enlargement and
deformities of the interphalangeal joints. There may be tenderness and
occasionally other signs of inflammation. There is often a partial loss
of range of motion and subluxation
70. A predominantly palmar subluxation may give the appearance of a mallet finger
OA of the first CMC joints (trapeziometacarpal and trapezioscaphoid) is common. There is
a tendency for osteophytes to develop on the distal ulnar surface of the trapezoid,
associated with radial subluxation of the proximal head of the first metacarpal. This gives
the base of the thumb a “squared” or “knobby” clinical appearance
71. Hips
Patients with hip OA most often have groin or anterior hip pain that radiates into the thigh.
Pain is associated with early ambulation and weight bearing and is lessened or relieved by
rest. Examination most often reveals difficulty rising from a seated position, altered gait
favoring the arthritic hip, and reduced range of motion on examination, with pain on
motion, particularly internal rotation.
72.
73. Both lumbar spine and hip OA may be painful when the patient rises from a seated or
reclined position and during early ambulation. Pain from lumbar stenosis often has its
onset after ambulation for a distance and, because of radiation to the thighs, is more
suggestive of claudication (pseudoclaudication). More severe hip OA may be painful at all
times, even at rest. Pain is usually localized to the groin or medial thigh but may be lateral,
suggesting (and associated with) trochanteric bursitis and/or meralgia paresthetica.
74. Hip OA is associated with an antalgic gait, one in which the patient overshifts the weight
while walking to reduce the pain
The Trendelenburg sign may be present: standing on the involved extremity leads to a
drop in the contralateral hip from weakening of the ipsilateral hip abductors. Another late
sign is shortening of the extremity as the femoral head migrates superiorly and axially into
the acetabulum, in association with a flexion contracture of the hip.
75. Most hip OA is slowly progressive. However, there is a subset of
patients, estimated at 10%, with a rapidly progressive form of
hip OA that evolves over a few months.
76.
77.
78. Knee
Patients often experience an insidious onset of pain about the knee, particularly with
weight bearing and stair climbing (gonarthritis). The patient may have noticed knee
swelling and/or varus/valgus deformity. Examination sometimes reveals swelling with loss
of the usual crease in the skin and soft tissues over the inner (null) facet between the
patella and the femoral condyle, in addition to a bulging suprapatellar sac. When present,
the effusions are usually cool to palpation
Hips
79.
80. Crepitus on motion is best detected on active joint motion.
Occasionally distention of the popliteal semitendinosus bursa
(popliteal or Baker cyst) may be present.
81. Marginal osteophytes, intrasynovial loose bodies (joint mice), or
moveable bodies (osteochondromas) may be palpable. Medial narrowing
of the joint space (radiographic interbone distance) may lead to or
aggravate a varus deformity, whereas lateral joint space narrowing may
lead to a valgus deformity
82.
83. Knee OA also has been associated with quadriceps weakness, reduced knee
proprioception, and increased postural sway
Knee OA may be associated with pain at the distal medial joint margin (anserine bursitis at
the insertion on the pes anserinus of the tibia).
Other structures affected in Knee OA
84. Adult patellofemoral OA is not commonly symptomatic. Anterior knee pain is aggravated
by sitting in low chairs (e.g., at movie theaters) and can be precipitated by pressure with
mediolateral movement of the patella in the intercondylar groove (patellar apprehension or
grind test).
OA of the knee may be associated with varying degrees of subchondral spontaneous
osteonecrosis of the knee.
85.
86.
87. Talonavicular and subtalar joint OA is usually secondary to trauma with or without
ligamentous damage or to an old ankle fracture. Patients complain of ankle pain on weight
bearing. Examination reveals swelling of the ankle that must be distinguished from a
variety of conditions, such as Achilles bursitis, plantar fasciitis, talocalcaneal coalition,
painful os trigonum, posterior tibial tendinitis, and pedal edema.
Ankle
88. Patients with OA of the feet most often present with pain of the first metatarsophalangeal
(MTP) joint, particularly with walking. Examination commonly reveals an enlarged joint,
with medial subluxation and lateral deviation of the big toe (bunion deformity). There are
sometimes signs of inflammation over the involved joint, with tenderness and loss of
dorsiflexion.
89. There is often painful and tender swelling of foot joints. Associated
contractures of additional toes (cock-up deformity) with loss of plantar fat
pads are often seen. Disabling pain on ambulation may ensue. Pes planus,
with relaxation of the transtarsal ligament and a pronator forefoot
deformity, aggravates the symptoms
90. The talonavicular joint is at the pinnacle of the arch of the foot and is
particularly prone to OA in the dorsal portion of the joint.
91.
92.
93.
94.
95. OA variants
1.Menopausal, inflammatory, nodal, generalized (or erosive) OA.
2.Rapidly progressive hip or knee OA.
3.Neuropathic arthropathy (Charcot’s joints).
4.Diffuse idiopathic skeletal hyperostosis (DISH)
96. This condition is characterized by the formation of bridging enthesophytes in the
spine, as well as enthesophytes and osteophytes in peripheral joints, and people with it
often have OA
DISH
97. No single lab test diagnoses OA by itself
Synovial fluid from patients with OA is usually clear and colorless or with a slight yellow
tinge. The polymorphonuclear leukocyte content is usually less than 2000 cells/mL.
Crystals may be present in as many as 70% of synovial fluid specimens from patients with OA.Although all calcium crystals
have been shown to precipitate inflammation, the relationship of hydroxyapatite and several forms of basic calcium phosphate
to the synovitis that is present in patients is not well established.
Evaluation
98. Cause of Secondary OA Laboratory Test
Underlying joint disease
ESR, CRP raised in inflammatory desease; autoantibodies such as RF and ANA in
connective tissue disease
Systemic metabolic or endocrine disorder
Ochronosis Presence of homogentisic acid in urine which turns black on exposure to light or on
alkalinization
Wilson’s disease Reduced serum caeruloplasmin; increased urinary excretion of copper
Hemochromatosis Raised serum iron; raised serum ferritin
Acromegaly Raised growth harmone with lack of suppression with a glucose tolerance test.
Hyperparathyrodism Raised serum calcium; low phosphate; raised parathyroid hormone levels.
Hypothyroidism Low serum thyroxin; raised thyroid-stimulating hormone Raised serum urate
Neuropathic disorder
Tabes dorsalis Positive VRDL; positive TPHA and FTA-ABS test.
Diabetes mellitus Abnormal glucose tolerance test
Laboratory tests in secondary osteoarthritis
99. Conventional radiography
In OA, subchondral sclerosis and osteophytosis are generally the earliest radiographic
features. They increase with time in both extent and size and precede radiographic joint
space narrowing which occurs at a later stage of the disease
Imaging
100. Pathology
Increased activity of
subchondral bone
Increased activity at the
articular margins
Altered bone
biochemistry
Altered articular cartilage
biochemistry
Cartilage fissuring and
rupture
Early disease
Bone alters early in
the disease due to the
blood supply
Later disease stage
Biomechanically
weaker bone
Early disease stage
Cartilage
biomechanically
weaker
Later disease stage
Focal loss and
removal of Cartilage.
Radiology
Increased subchondral cortical
plate and trabecular thickness
Incresed subarticular
trabecular osteoporosis
Osteophytosis
Remodelling of joint surface,
cyst formation, and later
altered joint alignment
Narrowing of joint space due
to cartilage compression
Loss of joint space
The pathologic features of
osteoarthritis determines the
characteristic radiographics
features
101. a) Pathologic changes in osteoarthritis and the corresponding
characteristic radiographic features visualized in plain
radiographs of joints with early- and late-stage disease.
b) Radiograph of a healthy knee.
c) Radiograph of a knee with late disease showing most of the
features listed in (a).
102. Osteophytes form as outgrowths at articular margins, capsular insertions, and central
articular regions in the unloaded region of joints
Osteophytes
103. Increased subchondral cortical plate thickness and subjacent trabecular sclerosis are
among the earliest changes in OA. Subchondral bone also demonstrates trabecular loss,
which becomes marked with advancing disease and increased local bone turnover results
in younger, less highly mineralized bone.
Radiolucencies noted in the subchondral bone may be juxtaarticular erosions or
subchondral cysts, which tend to occur in more advanced OA at sites of increased
mechanical load and frequently communicate with the articular surface.
Subchondral bone changes
104. Joint space narrowing is focal and not uniform, reflecting asymmetric cartilage loss across
the articular surface.1 This feature can prove useful in distinguishing early OA from other
arthritides such as rheumatoid arthritis.
Joint space narrowing
105. Subchondral bone in OA patients is mechanically weaker than that in individuals with
nonarthritic joints. It is detected radiographically as flattening and increased congruity
between the articular surfaces . With cartilage loss in the load-bearing compartment,
tongue-and-groove corrugation may develop, and with complete loss of cartilage the
subchondral bone is further flattened . Ultimately, the surfaces become deformed, with the
collapse of the bone leading to altered limb alignment and deformity.
Bone remodeling and attrition
107. The most reliable and reproducible method for imaging the tibiofemoral compartment of
the knee is the standing semiflexed view.
The patellofemoral compartment can be assessed using either a lateral or a “skyline”
(axial) view
Hip radiographs are conventionally taken with the hip in 15 to 20 degrees of internal
rotation.
The optimal view for imaging the hand is a dorsopalmar view with the fingers in line with
the forearm when laid flat on the x-ray detector holder.
Radiographic views
108. Kellgren-Lawrence (KL) grading system remains the most widely used scale to quantify
radiographic OA lesions. The KL system grades radiographic findings on a scale of 0 to 4
by assessing the presence and severity of osteophytes, joint space width, subchondral bone
sclerosis, and deformity of bone contour.
Radiographic grading systems
109. Discordance among radiographic change, clinical symptoms, and the degree of disability
experienced by patients;
Relation to clinical features
110. At present, given the absence of structure-modifying therapies, MRI has little use in the
routine clinical management of OA
MRI OA of the knee can be defined as the presence of both full-thickness cartilage loss
and definite osteophyte formation
MRI
111. The most common MRI-detected subchondral bone abnormality is manifested as a high-
signal area seen on fat-suppressed T2-weighted or short tau inversion recovery (STIR)
sequences and has been referred to as a bone marrow lesion (BML)
Changes noted on MRI
112. Coronal T2-weignt fat suppressed magnetic resonance image
of the knee demonstrating bone marrow lesion and cartilage
loss on both sides of the medical joint.
The medical meniscus is markedly degenerate with
maceration and abnormality increased signal (straight
arrow) compared with the normal lateral meniscus (curved
arrow). Abnormally increased signal is also seen on both
sides of the medical collateral ligament (arrowheads).
113. Changes noted on MRI
Subchondral bone marrow changes
Bone attrition
Cartilage abnormalities
Fibrocartilage and ligament abnormalities
Synovitis and joint effusion
Erosion
Osteophytes
114. US has been shown to be more accurate than radiography at detecting cortical erosions in
inflammatory arthritis
US can detect early bone changes in OA as a hyperechoic signal in the area of the
attachment of the joint capsule to the bony cartilaginous margin. This corresponds with the
eventual appearance of osteophytes seen on the conventional radiograph
Ultrasound
115. US readily demonstrates joint effusion and synovitis, although this is easier in some joints
than in others
Synovitis and effusion were particularly prevalent in those with erosive OA rather than
nonerosive OA
116. Sonogram of the knee joint (taken
longitudinally through the suprapatellar
pouch). The anterior cortex of the femur is
shown (black arrow head). A knee joint
effusion (Eff) and synovitis are apparent in the
suprapatellar pouch (white arrows)
117. US is more sensitive than clinical examination at detecting
synovial hypertrophy and effusions, and US detection of gray-
scale synovitis has been validated against arthroscopic biopsy
results and MRI detection of synovitis in large-joint OA.
118. US is highly operator dependent, and adequate training is required.
The current roles of US in OA may be acting as a tool for guiding intraarticular injections,
helping to differentiate OA from inflammatory diseases, and confirming the presence of
osteophytes to support a diagnosis of OA.
Clinical use of ultrasound
119. CT does not yet have an established role in OA trials or clinical practice and has the
drawbacks of low soft tissue contrast and radiation exposure.
Particularly effective at depicting cortical bone and may be useful when detailed
presurgical planning is required. CT has an established role in assessing facet joint OA of
the spine. CT arthrography, using a contrast medium, has the ability to clearly image the
articular surface of a joint, and this technique is comparable to MRI for qualitative
assessment of knee cartilage.
Computed tomography / Computed tomographic arthrography
120. Assessment of pain
The instruments most often used to date to evaluate pain in OA include both generic pain
measures, most notably a visual analogue scale or numeric pain rating scale,12 the McGill
Pain Questionnaire,13 and the SF-36 bodily pain scale,14 and arthritis-specific measures,
including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
pain scale (specific to hip and knee OA)15 and the Australian-Canadian Hand
Osteoarthritis Index (AUSCAN; specific to hand OA)
Physical function :The most commonly used generic measure for hip and knee OA is the
physical function subscale of the SF-36
Outcome measurement
121. Measure ICF Domain
Impairments Activity limitation Participation restriction
Generic Measures
SF-36 Pain +Stiffness Physical Functioning Social functioning.
Arthritis- and osteoarthritis-specific measures
WOMAC Pain+
Stiffness
Pain++
Physical function
KOOS/HOOS Symptoms
Stiffness Pain
Quality of life.
Pain
Function, daily living
Function, Sports and
recreational activities
Quality of life+
Lequesne indices Pain + Stiffness ADL knee
ADL hip++
Pain++
Walking
ADL hip+
OAKHQOL Pain / Sleep
Mental health
Physical Activity Social activities
ICF Domains assessed by selected outcomes measures.
122. No Disease
Preclinical
Biochemical markers
Preradiographic
Sensitive imaging
markers
Radiographic
Progression
markers
Preclinical OA
Primary Prevention
(no detected disease)
Secondary Prevention
(those with serologic
abnormalities, not just
traditional risk factors).
Tertiary Prevention
(those with disease).
OSTEOARTHRITIS CONTINUUM AND TREATMENT
124. ACTIVATED INNATE
IMMUNITY AND
IMPAIRED WOUND
HEALING
POTENTIATORS
INSULTS
Activated
Macrophages
Complements
Alarmins
Extrinsic Inciting Agents
Macroinjury
Microinjury
Environment
Intrinsic Risk Factors
Age
Obesity
Gender
Genetic susceptibility
Level of repair and innate
immune responses OA
Preclinical Preradiographic Radiographic
This model depicted osteoarthritis (OA) as
a condition incited by the mechanical
insults of microinjury, macroinjury, and
environmental factors. The interaction of
extrinsic inciting insults with potentiating
intrinsic factors determines the relative
susceptibility to progression of disease
mediated by a biologic innate immune
inflammatory reasons. Analogous to a
chronicle wound. The resulting pathology
is a manifested first as a preclinical (not
clinically recognizable) entity. With
progression in some individual to
Preradiographic stages (detected by
sensitive imaging modalities) and
eventually to readiographic stages. The
interacting cogwheels, able to turn
intermittently depict the penchant for OA
activity to wax and wane. The exact timing
of the onset of the illness of OA that
includes symptoms in this continuum of
OA pathogenesis is unclear at present.
126. Joint Destruction
Primary (No major causative
reasons known )
Secondary
Articular gout Bone infarction
Endocrine disorder
(e.g.,hyperparathyroidism, hypothyroidism)
Hemophilia
Intraarticular infections
Joint instability (e.g., ligament and
meniscus)
Neuropathic arthritis (e.g., Charcot joint)
Overload causing excessive wear (Work,
Sports, Varus or Valgus deformity)
Paget disease Trauma
127. In osteoarthritis (OA) the articular
cartilage is lost or severely thinned,
the (subchondral) bone is sclerotic,
the joint capsule is thickened, and
the synovial membrane is activated.
(Courtesy E.Bartnik, Frankfurt.)
Scheatic view of the main structures of a healthy (left) and
osteoartritic (right joint.)
128. Macroscopic
appearance of the
femoral condyles of
a normal knee.
Femoral condyles of
a severely damaged
knee.
Arthroscopic image
of a cartilage defect
of the femoral
condyle within the
knee joint.
129. Conventional histologic
preparations show fibrillation
and matrix los in
osteoarthritic (OA) cartilage
(b) compared with normal
cartilage (a). In severely
damaged areas nearly all
articular cartilage is
destroyed. Also a moderate
(d) to severe (e) loss of
proteoglycans blue staiming.
Besides changes in articular
cartilage, changes in the
subchondral bone plate (f)
compared with normal (c).
130. The lymphocytic infiltrate in the subsynovial stroma appears to correlate directly with
interleukin-1β (IL-1β) in the synovial fluid as well as matrix metalloproteinase-1
expression by synoviocytes, which suggests a direct stimulatory role of the inflammatory
cells on the activity of the synovial lining cells. The presence of inflammation in a
significant portion of OA patients points to the option of antiinflammatory therapy for
some subsets of OA patients.
Inflammatory OA
131.
132. The hallmark of OA cartilage degeneration is a loss of
cartilage matrix homeostasis.
139. Chondrocytes sense and respond to mechanical stimuli transmitted through the matrix. The
mechanical forces are recognized by mechanoreceptors such as integrins and stretch-
activated ion channels. Activation of these transmembrane molecules by physiologic
mechanical loads results in stimulation of a series of regulatory molecules and intracellular
signal cascades including FAK, PKC, JAK/STAT and MAP kinases that ultimately leads
to changes in gene expression and protein production. Thus an anabolic response is
produced that maintains, and in some circumstances improves, cartilage structure and
function.
Response to mechanical forces
140. Anabolic responses resulting in increased expression of aggrecan and inhibition of
protease production involve α5α1 integrin and release of locally acting mediators that
include interleukin-4 and substance P.
141. In contrast, overloading induces a stress response with molecular and biomechanical
changes that shift the balance of tissue remodeling in favor of catabolic over anabolic
activity
142. Stimulation of stress-induced intracellular pathways leads to the production of
proinflammatory cytokines such as IL-1 and TNF-α and increased production of MMPs
and aggrecanases. Interestingly, chondrocytes from OA cartilage show an altered
responsiveness to mechanical loads because they fail to show an anabolic response to
physiologic loading but instead demonstrate a proinflammatory IL-1β-dependent response.
This may further accelerate disease progression and attenuate cartilage repair.
143. Relevance of the genetic aspects of OA joint disease is still under debate.
Genetics
144.
145.
146. There are many different hypotheses that try to explain cartilage and joint degeneration,
including chronic mechanical (over)load, matrix proteolysis, age-induced changes in the
cartilage matrix and the chondrocytes, and increasing damage to the genomic DNA of the
chondrocytes leading to a deranged cellular phenotype.
Biomechanical factors are essential in the pathogenesis of OA. Altered joint biomechanics
are generated by joint incongruity, laxity, muscle weakness, and impaired proprioception
in addition to trauma and heavy physical load.
The production of proinflammatory cytokines as well as the activation of cellular
inflammatory signaling pathways, including interleukin-1 and the MAP kinases, likely
play an important role in OA pathogenesis.
Summary
a) Pathologic changes in osteoarthritis and the corresponding characteristic radiographic features visualized in plain radiographs of joints with early- and late-stage disease. (b) Radiograph of a healthy knee. (c) Radiograph of a knee with late disease showing most of the features listed in (a).