Osteoarthritis 1583-170210113823

Osteoarthritis
Definition
Osteoarthritis (OA), which is also known as

osteoarthrosis or degenerative joint disease
(DJD):
is a progressive disorder of the joints caused
by gradual loss of cartilage and resulting in the
development of bony spurs and cysts at the
margins of the joints.
Epidemiology
OA is the most common form of arthritis and

the most common joint disease
Characterized by degeneration of articular
cartilage
Leads to fibrillation, fissures, gross ulceration
and finally disappearance of the full thickness
of articular cartilage
Commonly Affected Joints
Uncommonly Affected Joints
• Shoulder
• Wrist
• Elbow
• Metacarpophalangeal joint
• TMJ
• SI
• Ankle
Joint Protective Mechanisms
Joint Capsule
Ligaments
Muscle
Sensory afferents
Underlying bone
OA is primarily disease of
cartilage.
Il-1 is a potent pro-
inflammatory cytokine, which
capable of inducing
chondrocytes and synovial
cells to synthesize MMPs.
MMPs is responsible of
degradation of articular
cartilage.
In addition, IL-1 inhibits

synthesis of collagen II,
proteoglycans and growth
factor B stimulated
chondrocyte proliferation
Risk Factors
Age
 Age is the most potent risk factor for
OA
 OA is rare in under age 40
 OA occurs in more than 50% of
persons over age 70
Risk Factors
Female gender
In general, arthritis occurs more frequently
in women than in men. Before age 45, OA
occurs more frequently in men; after age
45, OA is more common in women. OA of
the hand is particularly common among
women.
Risk Factors
Hereditary Gene defect
A defect in one of the genes

responsible for the cartilage
component collagen can cause
deterioration of cartilage.
Risk Factors
Joint’s Abnormalities
 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.
Risk Factors
Obesity
 Being overweight during midlife or
the later years is among the
strongest risk factors for OA of the
knee
Risk Factors
Joint overuse or injury

 Traumatic injury (ex. Ligament or
meniscal tears) to the knee or hip
increases your 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
Sources of pain
Increase hemostatic pressure within bone rise

in OA
Bone marrow edema
Synovial inflammation
Joint effusions
Osteophytes
Symptoms & Signs
 Pain increases with activity and worse at night.

 Morning Stiffness less than 30 mins
 Swelling
 Deformities
 Joint instability
 Loss of function
 Neurological signs if spine Involved.
 Crepitus
 Muscle wasting
Diagnosis – Blood Tests
No Blood tests are routinely indicated for

workup of patients with OA unless
symptoms & signs suggest inflammatory
arthritis.
Diagnosis – Synovial Fluid
Examination of the synovial fluid is more

helpful diagnostically than an X-Ray.
Synovial Fluid in OA:

WBC<1000/mm3
Clear color
High Viscosity
Diagnosis – Radiography
X-Rays are indicated to evaluate chronic hand

pain and hip pain thought to be due to OA
For knee pain, X-Ray should be obtained if

symptoms or signs are not typical of OA or
Pain persists after inauguration of effective
treatment
Radiographic Features
Erosion
Bone Cyst
Subchondral Sclerosis
Osteophytes
Narrow Joint Space

Radiographic Features
Differential Diagnosis
Rheumatoid Arthritis
Gout
CPPD (Calcium pyrophosphate crystal
deposition disease)
Septic Joint
Polymyalgia Rheumatica
DISH
Management of OA
GOALs:
Educate patient about disease & management
Improve function
Control pain
Alter disease process and its consequences

Management of OA
Treatment of OA:
Pharmacotherapy
Non Pharmacotherapy
Patients with mild and intermittent symptoms
may need only Non Pharmacotherapy
Patients with ongoing, disabling pain are likely
to need both Non Pharmacotherapy and
Pharmacotherapy
Non Pharmacotherapy
Avoid unnecessary stress
Increase muscle strength

Reduce Load on the
Non Pharmacotherapy
joint
Use of walking stick
Exercise
Weight loss
Correction of Malalignment
Pharmacotherapy
Lifestyle Modifications Acetaminophen PRN
NSAIDs PRN Celecoxib
Steroid Injections Opioids PRN
Hyaluronan Injections
Surgical Referral
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Osteoarthritis

Osteoarthritis (OA), which is also known as

OA is the most common form of arthritis and

In addition, IL-1 inhibits

Hereditary Gene defect

A defect in one of the genes

Joint overuse or injury

Increase hemostatic pressure within bone rise

 Pain increases with activity and worse at night.

No Blood tests are routinely indicated for

Examination of the synovial fluid is more

Synovial Fluid in OA:

X-Rays are indicated to evaluate chronic hand

For knee pain, X-Ray should be obtained if

Narrow Joint Space

Alter disease process and its consequences

Avoid unnecessary stress

Increase muscle strength

NSAIDs PRN Celecoxib

Steroid Injections Opioids PRN

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