Osteoarthritis is a degenerative joint disease characterized by cartilage breakdown. It is the most common form of arthritis, often affecting the knees in 70% of people over age 60. Osteoarthritis can cause functional impairment and disability in older adults and is a leading cause of joint replacement surgery. Risk factors include age, obesity, genetics, and joint trauma. Treatment focuses on reducing pain and preserving function through lifestyle changes, physical therapy, braces, and medications like acetaminophen, NSAIDs, and opioids. Surgery is considered for severe, treatment-resistant cases.
2. Osteoarthritis (OA): is a degenerative joint
disease characterized by the breakdown of the
joint's cartilage. It called degenerative joint
disease.
the most common form of arthritis.
3. EPIDEMIOLOGY
Osteoarthritis(OA) is the most common
joint disease
OA of the knee joint is found in 70% of
the population over 60 years of age
Radiological evidence of OA can be
found in over 90 % of the population
4. LIMITED FUNCTION
OA may cause functional loss of daily
living Activites
Most important cause of disability in
old age
Major indication for joint replacement
surgery
11. PATHOLOGY OF OA
Fibrillation
Eburnation
Osteophytes
Subcondral cysts
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Natural history of OA: Progressive
cartilage loss, subchondral thickening,
marginal osteophytes
13.
14. CLINIC OF OA
SIGNS AND SYMPTOMS
Joint pain - degenerative
Stiffness following inactivity – 30 min
Limitation of ROM – later stages
Deformity – restricition of ADL
15. OA OF KNEE JOINT
More common in obese females
over 50 years of age
Joint stiffness (<30 minutes)
Mechanical pain
Physical examination findings: Crepitus
Pain on pressure
Painful ROM and functional limitation
Limitation of ROM in later stages of OA (first
extension)
Laboratory analysis within normal limits
33. Secondary OA: Diabetic Neuropathy
• MTPs 2 to 5 involved
in addition to the 1st
bilaterally
• Destructive changes
on x-ray far in excess
of those seen in
primary OA
• Midfoot involvement
also common
34. Underlying Disease Associations of
OA and CPPD Disease (pseudogout)
• Hemochromatosis
• Hyperparathyroidism
• Hypothyroidism
• Hypophosphatasia
• Hypomagnesemia
• Neuropathic joints
• Trauma
• Aging, hereditary
35. TREATMENT OF OA
• Symptomatic treatment
• Structure modifying treatment
• Surgical treatment
37. PRIMARY PREVENTION OF OA ??
• Regular exercises
• Weight control
• Prevention of trauma
38. AIMS OF OA TREATMENT
• Pain relief
• Preservation and restoration of joint
function
• Education
39. Non-Pharmacologic Treatment of OA
• Patient education
• Weight loss (if overweight)
• Aerobic exercise programs
• Physical therapy
• Range-of-motion exercises
Muscle-strengthening exercises
• Assistive devices for ambulation
Patellar taping
Appropriate footwear
Lateral-wedged insoles (for genu varum)
• Bracing
• Occupational therapy
• Joint protection and energy conservation
40. PHARMACOLOGIC TREATMENT OF OA
• Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
• Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
• Topical agents
41. Nonopioid Analgesic Therapy
• First-line—Acetaminophen
• Pain relief comparable to NSAIDs, less toxicity
• Beware of toxicity from use of multiple
acetaminophen-containing products
• Maximum safe dose = 4 grams/day
42. Nonopioid Analgesic Therapy (cont’d)
• NSAIDs
• Use generic NSAIDs first
• If no response to one may respond to another
• Lower doses may be effective
• Do not retard disease progression
• Gastroprotection increases expense
• Side effects: GI, renal, worsening CHF, edema
• Antiplatelet effects may be hazardous
43. Nonopioid Analgesics in OA
• Cyclooxygenase-2 (COX-2) inhibitors
• Pain relief equivalent to older NSAIDs
• Probably less GI toxicity
• No effect on platelet aggregation or bleeding time
• Side effects: Renal, edema
• Older populations with multiple medical problems
not tested
• Cost similar to generic NSAIDs plus proton pump
inhibitor or misoprostol
Medical Letter. 1999;41:11–12.
44. Medical Letter. 1999;41:11–12.
Nonopioid Analgesics in OA (cont’d)
• Tramadol
• Affects opioid and serotonin pathways
• Nonulcerogenic
• May be added to NSAIDs, acetaminophen
• Side effects: Nausea, vomiting, lowered seizure
threshold, rash, constipation, drowsiness,
dizziness
45. Opioid Analgesics for OA
• Codeine, oxycodone
• Anticipate and prevent constipation
• Long-acting oxycodone may have fewer CNS side
effects
• Propoxyphene
• Morphine and fentanyl patches for severe
pain interfering with daily activity and sleep
46. Topical Agents for Analgesia in OA
• Local cold or heat: Hot packs, hydrotherapy
• Capsaicin-containing topicals
• Use well supported by evidence
• Use daily for up to 2 weeks before benefit
• Compliance poor without full instruction
• Avoid contact with eyes
• Liniments = methyl salicylates
• Temporary benefit
47. OA: Intra-articular Therapy
• Intra-articular steroids
• Good pain relief
• Most often used in
knees, up to q 3 mo
• With frequent injections,
risk infection, worsening
diabetes, or CHF
• Joint lavage
• Significant symptomatic
benefit demonstrated
• Hyaluronate injections*
• Symptomatic relief
• Improved function
• Expensive
• Require series of
injections
• No evidence of long-
term benefit
• Limited to knees
* Altman, et al. J Rheumatol. 1998;25:2203.
48. OA: Unconventional Therapies
• Polysulfated glycosaminoglycans—
nutriceuticals
• Glucosamine +/- chondroitin sulfate: Symptomatic
benefit, no known side effects, long-term
controlled trials pending
• Tetracyclines as protease/cytokine inhibitors
• Under study
• Have disease-modifying potential
54. INDICATIONS OF SURGICAL
INTERVENTION
• Severe joint pain,
resistant to conservative treatment
methods
• Limitation of daily living activities
• Deformity, angular deviations, instability