1
Fifth stage
Medicine
Lec-5
.د
فاخر
22/12/2016
Osteoarthritis (OA)
Is the most common form of arthritis. It has a strong
relation with ageing as it’s a major cause of pain and
disability in older people
Osteoarthritis is characterized by focal loss of articular
cartilage, subchondral osteosclerosis, osteophyte formation
at the joint margin, and remodeling of joint contour with
enlargement of affected joints.
Prevalence
Females are more commonly affected except that hips OA
occurs equally in both sexes
By age of 65, 80% of people have radiological OA 25-30% of
them are symptomatic
The knee and hip are the principal large joints involved,
affecting 10-25% of those aged over 65 years. Even in joints
less frequently targeted by OA, such as the glenohumeral joint
and elbow.
Risk Factors
Increasing age
“excessive” joint loading & mobility
Abnormal mechanical forces
(e.g. varus & valgus knee deformities)
Race & female sex
Genetic predisposition
Obesity
(for knees & hands O.A.)
Muscle weakness
Prior joint disease
Pathology
Stages of cartilage loss
Superficial fissuring (fibrillation)
Erosions & deep ulcers
Thinning & hypo-cellularity
Areas of repair with fibrocartilage
subchondral
subchondral osteosclerosis
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Bone Changes
Subchondral sclerosis
Osteophytes
Subchondral cysts
Remodeling (shape changes)
Symptoms
Pain
• Insidious onset over months or years
• Variable or intermittent over time (‘good
days, bad days’)
• Mainly related to movement and weight-bearing, relieved by rest
Stiffness: Only brief (< 15 mins) morning stiffness and brief (< 5 mins)
Clinical signs
• Restricted movement due to capsular thickening, or blocking by osteophyte
• Palpable, sometimes audible, coarse crepitus due to rough articular surfaces
• Bony swelling around joint margins
• Deformity, usually without instability
• Joint-line or periarticular tenderness
• Muscle weakness and wasting
• Synovitis mild or absent
Clinical Patterns
• Localized interphalangeal OA. (usually DIP)
• Generalized OA.
• Loading / mobility related OA.
Localized interphalangeal OA (usually DIP) Heberden’s and Bouchard’s nodes
• Heberden’s nods appears slowly
• Female & male 10/1
• Strong genetic factor
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Generalized OA
• Usually post-menopausal women
• Affect 3 or more joints or joints group
• Usually starts in the interphalangeal joints (DIPs & PIPs)
• Tendency to O.A. at other sites specially knee
Investigations
XR findings
• Joint space narrowing
• Subchondral sclerosis
• Osteophyts
• Subchondral cysts
• Deformity contour, slipping XR patient
Treatment
Non pharmacological
Reduce obesity
Avoid static loading e.g. prolonged squatting
Pacing of activity
Exercise specially non weight bearing (bicycle)
Joint rest techniques :Neck collar
Osteoarthritis: lumbar vertebrae, advanced stages
Spinal stenosis: lumbar spine (MRI) due to O.A.
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Pharmacological
Oral analgesic : paracetamol
Topical : capsacin & NSAIDs
Systemic NSAIDs
Intra-articular steroids with careful precautions
Intra-articular hyaluronic acid products
Glucosamine & chondroitins sulfate
Surgical
1- Osteotomy
2- Total joint replacement (TJR)
3- Cartilage repair surgery (cartilage auto-graft). Highly specialized centers
Indications: uncontrolled pain & functional disability refractory to conservative
therapy