OsteoarthritisIntroductionBackgroundOsteoarthritis )OA( is the most common articular.disease worldwideIt also called degenerative joint disease, representsfailure of the diarthrodial )movable, synovial-lined(.joint
Idiopathic )primary( OA:The most common form of the disease, no • .predisposing factor is apparent: Secondary OApathologically indistinguishable fromidiopathic OA but is attributable to anunderlying cause
Pathophysiology• It involves the entire joint organ, including the subchondral bone and synovium.• Inflammation occurs as cytokines and metalloproteinases are released into the joint.• Osteoarthritis predominantly involves the weight-bearing joints, including the knees, hips, cervical and lumbosacral spine, and feet. Other commonly affected joints include the distal interphalangeal )DIP( and proximal interphalangeal )PIP( joints of the hands.• Cartilage is grossly affected.• Focal ulcerations eventually lead to cartilage loss and eburnation. Subchondral bone formation also occurs, with development of bony osteophytes.
The etiopathogenesis • Stage 1: Proteolytic breakdown of the cartilage matrix. Chondrocyte metabolism is ,affected leading to an increased production of enzymes, which includesmetalloproteinases )eg, collagenase, stromelysin( that destroy the cartilage .matrix :Stage 2fibrillation and erosion of the cartilage surface, with a subsequent release of .proteoglycan and collagen fragments into the synovial fluid :Stage 3The breakdown products of cartilage induce a chronic inflammatory response in thesynovium. Synovial macrophage production of cytokines, interleukin 1 )IL-1(, .tumor necrosis factor-alpha, and metalloproteinases, occurs . Tissue destructionthese events alter the joint architecture, and compensatory bone overgrowth occurs
Frequency InternationalOsteoarthritis is the most common articular disease. Estimates vary among different .populations
Mortality/MorbidityThe disease progression of osteoarthritis is characteristically slow, occurring over .several years or decades . Pain potential weight gain
RaceThe prevalence of osteoarthritis differsamong different ethnic groups.Whetherthese differences are genetic or due todifferences in joint usage related to life- .style or occupation is unknown
HeredityNo mutation has been identified in thecommon primary )i.e., idiopathic( form ofOA. Most of the mutations identified areassociated with relatively rare syndromesafeature of which can be classified assecondary OA
Sex.The likelihood increases with ageThe disease is equally common among men .and women aged 45-55 yearsAfter age 55 years, the disease becomes .more common in womenDIP and PIP joint involvement that results inHeberden and Bouchard nodes is more common in women
Age• occurs in 30% of affected individuals aged 45-65 years and in more than 80% by their eighth decade of life, although most are asymptomatic.
ClinicalHistoryPainInitially, symptomatic patients incur pain during activity,which can be relieved by rest and may respond to .simple analgesicsMorning joint stiffness usually lasts for less than 30 .minutes .Stiffness during rest )gelling( may developJoints may become unstable as the osteoarthritisprogresses; therefore, the pain may become moreprominent )even during rest( and may not respond to.medications
Physical.Signs limited to the affected joints .Malalignment with a bony enlargementMost cases of osteoarthritis do not involveerythema or warmth over the affected .joint)s(;an effusion may be presentLimitation of joint motion or muscle atrophy.around a more severely affected joint
: Sources of pain 1. Joint effusion and stretching of the joint capsule 2. Increased vascular pressure in subchondral bone 3. Torn menisci 4. Inflammation of periarticular bursae 5. Periarticular muscle spasm 6. Psychological factors 7. Crepitus )a rough or crunchy sensation( may be palpated during motion of an involved joint.
Causes• Risk factors : – Increasing age – Obesity – Female sex – Trauma – Infection – Repetitive occupational trauma – Genetic factors – History of inflammatory arthritis – Neuromuscular disorder – Metabolic disorder
Workup• Laboratory Studies• No specific laboratory abnormalities are associated with osteoarthritis )OA(. – Levels of acute-phase reactants and erythrocyte sedimentation rate are within the reference range. – Synovial fluid analysis usually indicates a WBC count below 2000/µL with a mononuclear predominance.
Imaging Studies• Radiography . – The presence of osteophytes )ie, spurs at the joint margins( is the most characteristic findings. – Other findings in osteoarthritis include asymmetric joint-space narrowing, subchondral sclerosis, and subchondral cyst formation.
Procedures• Arthrocentesis of the affected joint can help exclude inflammatory arthritis, infection, and/or crystal arthropathy.
Treatment• Medical Care• Nonpharmacologic interventions are the cornerstones of osteoarthritis )OA( therapy and include:• patient education• temperature modalities• weight loss• exercise• physical therapy• occupational therapy• joint unloading in certain joints )eg, knee, hip(.
Physical therapy – Aerobic and muscle-strengthening exercises. – Hydrotherapy. – Heat and capsaicin cream – Ice.
Pharmacologic therapy The goals : – pain alleviation – improvement of functional status. no practical medication-based disease or structure-modifying intervention has been proven.
: Treatment – Acetaminophen for mild or moderate pain without apparent inflammation. – Nonsteroidal anti-inflammatory drug )NSAIDs(. – Tramadol. – Muscle relaxants . – Contemplate intra-articular injections of glucocorticoids – Systemic glucocorticoids have no role – Intra-articular injections of hyaluronic acid )HA( are approved as symptomatic therapy of osteoarthritis in the knee – Judicious use of narcotics )eg, acetaminophen with codeine( is reserved for patients with severe osteoarthritis.
Surgical Care• Joint lavage:• Arthroscopy: for repairing meniscal tears, removing fragments of torn menisci that are producing symptoms(.• Osteotomy – malaligned hip or knee joint. – younger patients . – Osteotomy can lessen the pain, although it can lead to more challenging surgery later if the patient requires arthroplasty.• Arthroplasty – if all other modalities are ineffective and osteotomy is not viable or if a patient cannot perform his or her daily activities despite maximal therapy.
Follow-up• Overweight patients who have early signs of osteoarthritis )OA( or who are at high risk should be encouraged to lose weight.• Recommend quadriceps-strengthening exercises in patients with osteoarthritis of the knees.
Prognosis• The prognosis of osteoarthritis depends on joints involved and severity
Patient Education• Educate the patient on the natural history of and management options for osteoarthritis.• Explain the differences between osteoarthritis and other more rapidly progressive arthritides such as rheumatoid arthritis.
?Osteoarthritis: What Is ItAlso called "wear and tear" arthritis
Osteoarthritis: Symptomsslowly. pain or soreness ,stiff or creaky. In • the hands: bony enlargements in the fingers, which may or may not cause pain