osteoarthritis
DESCRIPTION
osteoarthritis managementTRANSCRIPT
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OSTEOARTHRITISPRESENTED BY: SAPEEDEH AFZAL ROLL # 10 GROUP: A-1
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ROAD MAP• PROTECTIVE MECHANISM OF SYNOVIAL JOINTS• WHAT IS OA• EPIDEMIOLOGY• DISTRIBUTION OF DISEASE.• AETIOLOGY & RISK FACTORS• PATHOGENESIS• CLINICAL FEATURES• DIFFERENTIAL DIAGNOSIS• INVESTIGATIONS• MANAGEMENT
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PROTECTIVE MECHANISM OF SYNOVIAL JOINTS
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WHAT IS OSTEOARTHRITIS ???
Osteoarthritis is a degenerative disease of
synovial joints characterized by focal loss
of articular hyaline cartilage with proliferation of new bone & remodeling of
joint contour.
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EPIDEMIOLOGY• Weight bearing joints e.g. knee & hip joints.
• Age > 65 years.– 80% have radiographic features.– 25-30% have symptoms.
• More common in women.
• Familial tendency.
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DISTRIBUTION OF DISEASE
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ETIOLOGY
• PRIMARY / IDIOPATHIC: When there is no obvious predisposing
factor. Common form of OA.
• SECONDARY: When degenerative joint changes occur in
response to a recognizable local or systemic factor.
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CAUSES OF SECONDARY OSTEOARTHRITIS
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RISK FACTORS
AGEING
CONSTITUTIONAL SUSCEPTIBILITY
MECHANICAL FACTORS
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PATHOGENESIS
• Progressive destruction & loss of articular cartilage with an accompanying peri-articular bone response leads to exposure of sub-chondral bone which becomes sclerotic, with increased blood vascularity & cyst formation.
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CLINICAL FEATURES• Pain:
– Activity & weight-bearing related, relieved by rest.
– Variable over time.– Only one or few joints involved.
• Morning stiffness only brief <30 minutes.
• Restricted functionality:– Capsular thickening.– Blocking by osteophytes.
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CLINICAL FINDINGS IN NODAL GENERALIZED OA
• Presentation typically in women. (40 & 50 years)
• Pain.
• Stiffness.
• Swelling of one or few finger interphalangeal joints ( distal > proximal).
• Heberden’s nodes (+/- Bouchard’s nodes).
• Involvement of first carpometacarpal joint is common.
• Predisposition to OA at other joints specially knees.
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CLINICAL FINDINGS IN KNEE OA• Targets patello-femoral & medial tibio-femoral compartments of knee.
• Pain is localized to anterior or medial aspect of knee & upper tibia.
• Jerky gait.
• Varus deformity.
• Joint line &/or periarticular tenderness.
• Weakness & wasting of quadriceps muscle.
• Restricted extension & flexion.
• Bony swelling around joint.
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CLINICAL FINDINGS IN HIP OA• Targets mostly superior aspect & less commonly medial aspect of joint.
• Pain is maximally deep in groin area.
• Antalgic gait.
• Weakness & wasting of muscles (quadriceps & gluteal).
• Pain & restricted internal rotation with flexion.
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CLINICAL FINDINGS IN EARLY-ONSET OA
• Before the age of 45 years.
• Single or multiple joint involvement.
• Typical signs & symptoms of OA.
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CLINICAL FEATURES IN EROSIVE OA
• Preferentially targeting proximal IPJs.
• Common development of IPJ lateral instability.
• Sub-chondral erosions on x-rays.
• Ankylosis of IPJs.
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DIFFERENTIAL DIAGNOSISFEATURES OSTEOARTHRITIS RHUEMATOID
ARTHRITISGOUT
PRESENCE OF SYMPTOMS AFFECTING THE WHOLE
BODY:
Systemic symptoms are not present.
Frequent fatigue and a general feeling of being ill
are present
Chills and a mild fever along with a general
feeling of malaise may also accompany the
severe pain and inflammation
DURATION OF MORNING STIFFNESS:
Morning stiffness lasts less than 30-60 mins;
Morning stiffness lasts longer than 1 hour.
Not seen
NODULES: Heberden's & bouchard's nodes
Heberden’s nodes are absent.
PAIN WITH MOVEMENT: Movement increases pain Movement decreases pain
AGE OF ONSET: Most commonly occurs in individuals over the age
of 50.
Usual age of onset is 20-40 years.
Usually over 35 yrs of age in men and after
menopause in females
LAB FINDINGS: Ra factor & anti-ccp antibody negative.
Normal esr & c-reactive protein.
Ra factor & anti-ccp antibody positive. Esr & c-reactive protein elevated.
Joint fluid microscopy is diagnostic.
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INVESTIGATIONS
• PLAIN X-RAY:
– JOINT SPACE NARROWING
– SUBCHONDRAL SCLEROSIS
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MARGINAL OSTEOPHYTES
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SUBCHONDRAL CYST
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• BLOOD TEST:– FBC NORMAL.– ESR NORMAL.– CRP NORMAL.– RHEUMATOID FACTOR NEGATIVE.
• SYNOVIAL FLUID ANALYSIS:– VISCOUS WITH LOW TURBIDITY.– CPPD & CALCIUM PHOSPHATE.
INVESTIGATIONS
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MANAGEMENT
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NON-PHARMACOTHERAPY– Full explanation of the condition via patient education:
• Properly position and support your neck and back while sitting or sleeping.
• Adjust furniture, such as raising a chair or toilet seat.
• Avoid repeated motions of the joint, especially frequent bending.
• Lose weight if you are overweight or obese, which can reduce pain and slow progression of OA.
• Exercise each day.
• Build confidence.
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NON-PHARMACOTHERAPY• Exercises:
• Aerobic conditioning.
• Muscle strengthening exercises.
• Reduction of adverse mechanical factors:• Weight loss.
• Pacing of activities.
• Appropriate footwear.
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PHARMACOTHERAPYPARACETAMOL•Initial drug of choice•Orally 1 gm 6-8 hourly
NSAIDs•Indicated as needed.•Oral e.g: ibuprofen & coxibs•Topically e.g: capsaicin 0.025% cream
WEAK OPIOIDS•Occasionally required.•e.g: dihydrocodeine
INTRA-ARTICULAR CORTICOSTEROIDS
INJECTIONS•3-5 weekly.
HYALURONIC INJECTIONS HYALURONIC INJECTIONS •Injections for 3-5 weeks.Injections for 3-5 weeks.•Pain relief for several months.
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SURGICAL TREATMENT• Should be considered for those who do not give response to
pharmacotherapy. – Osteotomy.– Joint replacement.– Total joint replacement.
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