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Published by: eaboulola on Mar 02, 2009
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It is a disease of synovial joint characterized by articular cartilage loss with an accompanying periarticular bone response. Note  it’s the most common form of arthritis.

• • • • World wide. Its twice as common in females as in males. There is marked familial tendency (35-65% from multiple genes). Primary OA uncommon before the age of 50 years.

• Primary  Unknown but affect elderly (more then 50 year old) and obese. • Secondary  when degenerative joint change occur in response to a recognizable local or systemic factor.

Causes of secondary OA:
• • • • • • • • • • • • 1 Hip dysplasia. RA. SLE. SCA. Gout. Paget's disease. Goucher's disease. Wilson's disease. DM. Tebes dorsalis. Syringomyelia. Peripheral nerve lesions.

Dr. julianajulie

• • • • • • • • •

Intra-articular fracture. Occuoational. Ehlers-Danlos syndrome. Mesicectomy. Hemophilia. Alkatonuria. Hemochrmatosis. Chondrocalcinosis. Acromegaly.

Pathology and Pathogenesis:
Different insult can start the degenerative process but the most obvious: • • Mechanical insult  trauma. Biochemical abnormalities  chondrocytes release enzymes that degrade collagen and protoglycan.

Progressive distruction and loss of articular cartilage  exposed subchondral bone become sclerotic  ↑ vascularity + cyst formation. Repair process produce cartilaginous growth at the margins of the joint  clacified  osteophtes.

Clinical Features:
• • • Pian  wores with motion and relieved by rest. Stiffness  after rest, there is transient morning stiffness for less then 30 minutes. Joints involved  distal interphalangeal joint, first carpometacarpal joint of the hand, first metatarsophalangeal joint of the foot, weight bearing joints, vertebra, hip and knee.

Note  elbow, wrist and ankle joint rarely affected. On Examination: • • Deformity. Bony enlargement.


Dr. julianajulie

• • • • •

Limited joint movement. Crepitus  common finding  due to disruption of normal smooth articulating surfaces of the joint  effusion maybe present. Muscle wasting. Heberden's nodes  swelling at DIPJ. Bouchard's nodes  swelling at PIPJ.

Note  type of swelling is hard swelling due to osteophtes formation. • • In knee, cartilage loss due to OA results in  Varus or Valgus angulation. Fluctuant swelling along posterior aspect of the knee, popliteal or Baker's cyst occur in some patients with knee effusion.

Note  Asymmetrical joint involvement.

Differential Diagnosis:
• • • • RA. Pyrophosphate arthropathy. Chronic tophaceous Gout. Psoriatic arthritis.

• • CBC and ESR  Normal. X-ray  only abnormal in advanced disease, shows narrowing of the joint space (due to loss of cartilage), ostoephytes, subchondral sclerosis and cyst formation.


Dr. julianajulie

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