osteoarthritis
Post on 14-Jun-2015
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OSTEOARTHRITIS
The most common arthritis in the UK
About 60-90% of people over age 65Under 45 years it is equally common in men and women
Over 55 years its more common in women
Premature OA associated with gene mutations that encode collagen types 2, 9, 10
Large economic impact as a result of medical costs
OA is a disease of joints that affects all of the weight-bearing components of the joint:
•Articular cartilage•Menisci•Bone
OA most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips
Risk factorsmetabolic (hemachromatosis) inflammatory (RA, infection)
agegender
genetic factorstraumaweight
Age
Age is the strongest risk factor for OA. Although OA can start in young adulthood, people over 45 years
old are at higher risk.
Female gender
In general, arthritis occurs more frequently in women than in men. OA of the hand is particularly common
among women.
Joint alignment
People with joints that move or fit together incorrectly, such as bow legs, a dislocated hip, or double-
jointedness, are more likely to develop OA in those joints.
Hereditary gene defectA defect in one of the genes responsible for the cartilage component collagen can cause deterioration of
cartilage.
Joint injury or overuse caused by physical labour or sports
Traumatic injury (ex. Ligament or meniscal tears) to the knee or hip increases the risk for developing OA
in these joints. Joints that are used repeatedly in certain jobs may be more likely to develop OA
because of injury or overuse.
Obesity
Being overweight during midlife or the later years is among the strongest risk factors for OA of the knee.
Symptoms• OA usually occurs slowly • Only a third of people
whose X-rays show OA report pain or other symptoms
– Steady or intermittent pain in a joint – Stiffness that tends to follow periods of inactivity, such as
sleep or sitting – Swelling or tenderness in one or more joints – Crunching feeling or sound of bone rubbing on bone
(crepitus) when the joint is used
Classification
Primary• Idiopathic• Localized or generalized• Local: knee, hip, spine,
hands• Generalized: large
joints and spine, Small peripheral joints and spine, Mixed and spine
Secondary• Post-traumatic• Congenital or
developmental• Localized or generalized• Calcium deposition
diseaseOther:• Inflammatory• Avascular necrosis
• Articular cartilage gets disrupted
• Damage progresses deeper to subchondral bone
• Fragments of cartilage released into joint
• Matrix degenerates
• Eventually there is complete loss of cartilage
• Bone is exposed
• Cartilage matrix has increased water content and decreased proteoglycan
• With aging cartilage dries up.• Increased activity of proteinases compared to inhibitors of
proteinases.• Breakdown products of cartilage cause inflammatory
reaction of synovium• Cytokines coming from chondrocytes cause matrix
degeneration.
• Cycle of destruction starts • Compensatory bone overgrowth occurs - subchondral bone
increases in density• Bony proliferations at joint margins form osteophytes• Cause joint motion restriction
Subchondral sclerosisJoint space narrowing where there is stress
Subchondral cystsOsteophytes
Examination
• Joint line tenderness• Bony enlargement of
joint• +/- effusion• Crepitus
• Decreased range of motion
Treatment• Non-pharmacokinetic
• NSAIDS• Analgesics (acetominophen)
• Topical pain releivers• Narcotics
• Intra-articular steroids• Chondroprotective agents
• Anti-depressants• Surgery
Non-pharmacokinetic:• Exercise – prevent disuse atrophy of muscles• Physical therapy: Hydrotherapy/heat/cold• Weight loss• Education • Wedges shoe insoles/braces/supportive devices
MedicationsWhen osteoarthritis flares up, many patients find relief with pain and anti-inflammatory medication, such as aspirin, ibuprofen, or acetaminophen. Pain-relieving creams or sprays can also help when applied directly to the sore area. If pain persists despite the use of pills or creams, injection of steroids or hyaluronans directly into the joint could be suggested.
Supplements: No benefits of glucosamine and chondroitin
Surgery• arthroscopy is not recommended for nonspecific
cleaning of the knee.
• Joint replacement: If all treatment is ineffective, and pain is severe, there is loss of joint function
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