OSTEOARTHRITIS

How OA may affect different parts of the body:

 Hips. Pain is felt in the groin area or buttocks and sometimes on the inside of the
knee or thigh.
 Knees. A “grating” or “scraping” feeling when moving the knee. 
 Fingers. Bony growths (spurs) at the edge of joints can cause fingers to become
swollen, tender and red. There may be pain at the base of the thumb.
 Feet. The big toe feels painful and tender. Ankles or toes may swell.

RISKFACTORS
Risk factors for osteoarthritis include the following.
 Age
 Obesity 
 Trauma
 Genetics (significant family history)
 Reduced levels of sex hormones
 Muscle weakness 
 Repetitive use (ie, jobs requiring heavy labor and bending)
 Infection
 Crystal deposition
 Acromegaly
 Previous inflammatory arthritis (eg, burnt-out rheumatoid arthritis)
 Heritable metabolic causes (eg, alkaptonuria, hemochromatosis, Wilson disease)
 Hemoglobinopathies (eg, sickle cell disease and thalassemia)
 Neuropathic disorders leading to a Charcot joint (eg, syringomyelia, tabes
dorsalis, and diabetes)
 Underlying morphologic risk factors (eg, congenital hip dislocation and slipped
femoral capital epiphysis)
  Disorders of bone (eg, Paget disease and avascular necrosis)
 Previous surgical procedures (eg, meniscectomy)
 Diabetes mellitus

SYMPTOMS

 Pain or aching in the joint during activity, after long activity or at the end of the
day.
 Joint stiffness usually occurs first thing in the morning or after resting.
 Limited range of motion that may go away after movement.
 Clicking or cracking sound when a joint bends.
 Swelling around a joint.
 Muscle weakness around the joint.
 Joint instability or buckling  (knee gives out).

DIAGNOSIS

Medical history, a physical examination and lab tests help to make an OA diagnosis. 

 Joint aspiration. After numbing the area, a needle is inserted into the joint to
pull out fluid. This test will look for infection or crystals in the fluid . The results
can help rule out other medical conditions or other forms of arthritis.

Imaging studies
 Computed tomography (CT) scanning
 Ultrasonography – used as a tool for monitoring cartilage degeneration, and it
can be used for guided injections of joints not easily accessed without imaging

 Bone scanning - May be helpful in the early diagnosis of osteoarthritis of the

hand
 X-ray. X-rays can show joint or bone damage or changes related
to osteoarthritis.
 MRI. Magnetic resonance imaging (MRI) gives a better view of cartilage and
other parts of the joint.

PATHOPHYSIOLOGY

osteoarthritis affects the articular cartilage of synovial joints, synovial fluid, as well as in
the underlying (subchondral) bone, the overlying joint capsule, and other joint tissues.

inflammation occurs as cytokines and metalloproteinases are released into the joint.
These agents are involved in the excessive matrix degradation that characterizes
cartilage degeneration in osteoarthritis..
There is an increase in IL-17 levels in the synovium of osteoarthritis joints.Other
inflammatory molecules that have been associated with osteoarthritis include 15‐
hydroxyeicosatetraenoic acid, prostaglandin E2, IL‐1β, IL‐1 receptor antagonist, and
uric acid. 

In early osteoarthritis, swelling of the cartilage usually occurs, because of the increased
synthesis of proteoglycans; this reflects an effort by the chondrocytes to repair cartilage
damage. This stage may last for years or decades and is characterized by hypertrophic
repair of the articular cartilage.

As osteoarthritis progresses, however, the level of proteoglycans eventually drops very

low, causing the cartilage to soften and lose elasticity and thereby further compromising
joint surface integrity. Microscopically, flaking and fibrillations (vertical clefts) develop
along the normally smooth articular cartilage on the surface of an osteoarthritic joint.

Over time, the loss of cartilage results in loss of joint space.

In major weight-bearing joints of persons with osteoarthritis, a greater loss of joint space
occurs at those areas experiencing the highest loads

Erosion of the damaged cartilage in an osteoarthritic joint progresses until the

underlying bone is exposed. Bone denuded of its protective cartilage continues to
articulate with the opposing surface.
Eventually, the increasing stresses exceed the biomechanical yield strength of the
bone. The subchondral bone responds with vascular invasion and increased cellularity,
becoming thickened and dense (a process known as eburnation) at areas of pressure.

TREATMENT

Nonpharmacologic interventions
The cornerstones of osteoarthritis therapy, nonpharmacologic interventions include the
following:
 Patient education
 Heat and cold
 Weight loss 
 Exercise
A good exercise program includes:
 Strengthening exercises build muscles around painful joints and helps to ease
the stress on them. 
 Range-of-motion exercise or stretching helps to reduce stiffness and keep
joints moving.
 Aerobic or cardio exercises help improve stamina and energy levels and
reduce excess weight.
 Balance exercises help strengthen small muscles around the knees and ankles
and help prevent falls.
  Physical therapy
 Occupational therapy
 Unloading in certain joints (eg, knee and hip)
 Control Blood Sugar - Having high glucose levels can make cartilage stiffer and more
likely to break down. Having diabetes causes inflammation, which also weakens cartilage

Pharmacologic therapy
For hand osteoarthritis, one or more of the following is recommeded:
 Topical capsaicin
 Topical nonsteroidal anti-inflammatory drugs (NSAIDs) - Including trolamine
salicylate – ther are the most commonly use dfor treatment of OA
 Oral NSAIDs
 Analgesics. These are pain relievers and include acetaminophen and opioids.
Acetaminophen is available over-the-counter (OTC), and opioids must be prescribed by a
doctor

For knee osteoarthritis, using one of the following is recommended:

 Acetaminophen
 Oral NSAIDs
 Topical NSAIDs
 Tramadol
 Intra-articular corticosteroid injections
For hip osteoarthritis, using 1 or more of the following for initial management is
recommeneded
 Acetaminophen
 Oral NSAIDs
 Tramadol
 Intra-articular corticosteroid injections
Surgery
Joint surgery can improve function or replace damaged joints to restore mobility and relieve
pain. Hips and knees are the joints most commonly replaced. Surgical procedures for
osteoarthritis include the following:
 Arthroscopy
 Osteotomy
 Arthroplasty - Particularly with knee or hip osteoarthritis
 Fusion