Professional Documents
Culture Documents
OSTEOARTHRITIS
LEARNING OUTCOMES:
At the end of this session students will be able to:
Define Osteoarthritis
Explain EPIDEMIOLOGY
List and explain CHARACTERISTICS of Osteoarthritis
List CLASSIFICATION of Osteoarthritis
List RISK factors of primary and secondary Osteoarthritis
Explain PATHOLOGY
List LABORATORY findings AND RADIOLOGIC FINDINGS of
Osteoarthritis
List CLINIC OF OA SIGNS AND SYMPTOMS
List and explain TREATMENT of Osteoarthritis
DEFINITION
Osteoarthritis OA is a degenerative
disease of diarthrodial (synovial) joints,
characterized by
Breakdown of articular cartilage
and proliferative changes of surrounding
bones
EPIDEMIOLOGY
Osteoarthritis(OA) is the most common joint
disease
OA of the knee joint is found in 70% of the
population over 60 years of age
Radiological evidence of OA can be found in over
90 % of the population
LIMITED FUNCTION
OA may cause functional loss
Activites of daily living
Most important cause of disability in old age
Major indication for joint replacement surgery
CHARACTERISTICS OF OA
OA is a chronic disease of the musculoskeletal
system, without systemic involvement
OA is mainly a noninflammatory disease of
synovial joints
No joint ankylosis is observed in the course of the
disease
CLASSIFICATION OF OA
Primary OA
Etiology is unknown
Secondary OA
Etiology is known
AGE
Primary OA > 40 years
Direct correlation
Aging process
Age
Sex
Obesity
Genetics
Trauma (daily)
SECONDARY OSTOARTHRITIS
Trauma
Previous joint disorders;
Congenital hip dislocation
Infection: Septic arthritis, Brucella, Tb
Inflammatory: RA, AS
Metabolic: Gout
Hematologic: Hemophilia
Endocrine: DM
ETIOLOGY OF OA
Cartilage properties
Biomechanical problem
MORPHOLOGY OF PRMARY OA
PRMARY GENERALZED OA
STRUCTURE OF JOINT
CARTILAGE
Collagen (Type 2)
Proteoglycan
- Hyaluronic acid
- Glycoseaminoglycan
Water
Condrocyte
Regeneration and Degeneration
PATHOLOGY OF OA
Fibrillation
Eburnation
Osteophytes
Subcondral cysts
LABORATORY FINDINGS OF OA
There are no pathognomonic laboratory
findings for OA
Laboratory analysis is performed for
differential diagnosis
RADIOLOGIC FINDINGS OF OA
Narrowing of joint space
(due to loss of cartilage)
Osteophytes
Subchondral (paraarticular) sclerosis
Bone cysts
RADIOLOGIC GRADE OF OA
G1
G2
G3
G4
Normal
Mild
Moderate
Severe
DIAGNOSIS OF OA
CLINICAL FINDINGS
Joint pain
+
RADIOLOGIC FINDINGS
Osteophytes
CLINIC OF OA
SIGNS AND SYMPTOMS
RADIOLOGIC FINDINGS?
GRADE 1 - 4?
OA OF HIP JOINT
More common in males over 40 years of age
Joint stiffness
Pain of hip, gluteal and groin areas radiating to
the knee (N obturatorius)
Mechanical pain
Limited walking function
COXARTHROSIS
Physical examination:
Antalgic limping
Limitation of ROM (first internal rotation)
Painful ROM
Trendelenburg test positivity
Leg length discrepancy
Laboratory analysis within normal limits
BIOMECHANICS
X-RAY OF HIP OA
PERPHERAL JONTS
Hands
Feet
ETIOPATHOGENESIS OF OA
Age,gender
Genetic
effects
Other factors
OA
Local
biochemical
ETIOPATHOGENESIS OF OA
Dysfunction of joint cartilage
Condrocyte function: 1- Degredative
enzymes
(metalloproteases)
2- Inhibitors
Degeneration and regeneration functions
are balanced
IL-1 , degredative enzymes + synovial
inflammation results: Breakdown of cartilage
PATHOGENESIS OF OA
Cytokines
Cell destruction
Membrane phospholipids
Arachidonic acid
Cox-1, Cox-2
TREATMENT OF OA
Symptomatic treatment
Structure modifying treatment
Surgical treatment
STRUCTURE MODIFYING
TREATMENT
Hyaluronic acid injection (HA)
Glycose amino glycans (GAG)
PRIMARY PREVENTION OF OA ??
Regular exercises
Weight control
Prevention of trauma
AIMS OF OA TREATMENT
Pain relief
Preservation and restoration of joint
function
Education
NON-PHARMACOLOGC
TREATMENT OF OA
Patient education
Weight loss (if overweight)
Aerobic exercise programs
Physical therapy
Range-of-motion exercises
Muscle-strengthening exercises
Assistive devices for ambulation
Patellar taping
Appropriate footwear
Lateral-wedged insoles (for genu varum)
Bracing
Occupational therapy
Joint protection and energy conservation
PHARMACOLOGIC TREATMENT OF OA
Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
Topical agents
SYMPTOMATIC TREATMENT OF OA
Decrease of joint loading
- Weight control
- Splinting
- Walking sticks
Exercises
- Swimming
- Walking
- Strengthening
Patient education
INDICATIONS OF SURGICAL
INTERVENTION
Severe joint pain,
resistant to conservative treatment methods
Limitation of daily living activities
Deformity, angular deviations, instability
INVASIVE METHODS
Joint lavage
Arthroscopy
Cartilage grefting- genetic engineering
Surgery
Osteotomy
Joint replacement
QUESTIONS?