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CASE :

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

RISK FACTORS FOR PRIMARY OA

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

Kellgren Lawrence Classification

DIAGNOSIS OF OA
CLINICAL FINDINGS
Joint pain
+
RADIOLOGIC FINDINGS
Osteophytes

CLINIC OF OA
SIGNS AND SYMPTOMS

Joint pain - degenerative


Stiffness following inactivity 30 min
Limitation of ROM later stages
Deformity restricition of ADL

OA OF KNEE JOINT (GONARTHROSIS)

More common in obese females


over 50 years of age
Joint stiffness (<30 minutes)
Mechanical pain
Physical examination findings: Crepitus
Pain on pressure
Painful ROM and functional limitation
Limitation of ROM in later stages of OA (first
extension)
Laboratory analysis within normal limits

GENU VALGUM - ORTHOSIS

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

IL-1, IL-6, TNF-

Cell destruction
Membrane phospholipids
Arachidonic acid
Cox-1, Cox-2

IL-1 and metalloproteases have been found


to play an important role in cartilage
destruction.
Local growth factors, especially transforming
growth factor (TGF) are involved in the
formation of osteophytes

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

HAND OA - RESTING SPLINT

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?

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