Osteoarthritis: OA

Janet Pope MD MPH FRCPC

Goals

• Identify the most common joints affected in OA

• Differentiate OA from RA• Describe the most common treatments for

OA including non-pharmological

Case: Diane

• This is a 62 year old woman with 3 kids• She has had on-going bilateral knee pain

for the past 3 years• It flares on and off• It tends to be worse when she is active• At times she has difficulty sleeping

because of knee pain

Diane has made some positive moves

• She manages to walk every morning when her knees are “feeling good”

• She lost 28 lbs and has kept it off for the last 5 years

• She is otherwise healthy and takes no other medications with the exception of occasional acetaminophen for her knees

OA Knee Xrays

• Often we order weight bearing views• AP knees standing• Joint space narrowing• Osteophytes, sclerosis, bony cysts• Joint space narrowing may be

assymetrical• Malalignment (ex valgus or varus

deformity)

Here are Diane’s Hands

Diagnosis

• Diane has osteoarthritis – OA / degenerative arthritis

• Osteoarthritis is the most common form of chronic arthritis

Osteoarthritis: Definition

• A joint disease characterized by:– Pain that typically worsens with weight

bearing and activity and improves with rest– Morning stiffness and gelling of the involved

joint after periods of inactivity– Tenderness on palpation, bony enlargement,

crepitus on motion, and/or limitation of joint motion

– There may be joint swelling and heat

ACR Recommendations: Arthritis Rheum 2000; 43(9):1905-15.

Osteoarthritis Facts

• OA affects 3,000,000 (1 in 10) Canadians1

• OA is associated with significant costs:2

– Direct (e.g., drugs, healthcare resource use)– Indirect (e.g., lost employment time, costs of

informal caregiving)• Under treatment leads to significant pain

and loss of quality of life

1 & 2 - Arthritis Society of Canada: www.arthritis.ca

Osteoarthritis: Clinical Characteristics

• OA is common• It is not always symptomatic• Usually insidious onset• Usually less than a half hour of am joint

stiffness• Younger age Men>women• Older age Women>men• Worse with activity• Better with rest

Bony Enlargement

DIP bony enlargementHeberden’s nodes

PIP bony enlargementBouchard’s nodes

Distribution of Joints• Hands:

– DIP, PIP, 1st CMC joints• Hip• Knee• Feet:

– First MTP• Spine

– Cervical, lumbar

OARA

First CMC OA –squaring at base of thumb