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pathology: osteoarthritis

Principles of Basic and Clinical Medicine (Anglia Ruskin University)

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osteoarthritis

• its a nonneorplastic degenerative disease of progressive erosion of articular cartilage

associated with aging, trauma or occupational injury;
• loss -> 1. loss of joint space 2. presence of osteophytes (bony projection) 3.
subchondral cysts 4. subchondral sclerosis

• arthropathies are joint-centered processed that might be primary (when it occurs in

the absence of other known arthritis) or secondary (the end stage of several types of
arthrtitis), inflammatory or non inflammatory
• if one surface at one side of the joint is only affected, the disease is unlikely to be
primary
• eburnation= creation of subchondral new bone formation after loss of articular
cartilage

• primary osteoarthritis= most common and the major weight-bearing joints, the hip,
knee and to a lesser degree the ankle
• common in the frequently used small joints of hands and wrists, particularly the first
carpometacarpal joints at the base of the thumbs
• the dominant hand is more severely affected than the non-dominant hand
• the facets joints of the cervical and lumbar spine are also commonly affected

pathophysiology of osteoarthritis
• cartilage has protective viscoelastic and compressive properties
• ECM, composed predominantly of type II collagen and proteoglycans
• normally, this matrix is subjected to a dynamic remodelling process in which low
levels of degradative and synthetic enzyme activities are balanced, such that the
volume of cartilage is maintained
• in osteoarthrtitis there is an increase in the matrix degrading enzymes which shifts
this balance causing degeneration and loss of collagen and proteoglycans from the
matrix

risk factors
• older age
• obesity
• joint injury or long-term overuse of joint
• family history
• malformed joints
• inactivity

symptoms
• symptoms include joint stiffness, reduced function, pain and swelling
• advanced symptoms include locking and giving way
• examination findings- crepitus, joint deformity, effusion
• management: supportive and self care- weight loss, local strengthening, heat/cold
packs; simple analgesia, physiotherapy, progress up the medication ladder
• possible surgical management with arthroscopy and wash out or knee replacement

radiological features
• joint space narrowing
• sclerosis
• osteophytosis
• joint erosion
• subchondral cyst

• possible presence of nodules that affect finger joints

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• bouchard’s nodule is proximal

• heberden’s nodule is distal
• MCP to proximal phalanges= RA
• inter pharyngeal joints= OA

• macroscopically when looking at bone= subchondral cyst

• to grade the disease and its severity, you can follow the grading scale that goes from
0 to 6
Rheumatoid arthritis

• inflammatory autoimmune joint disease

• occurs in old age, affecting many tissues but principally attacking the joints
• RA is a relative common condition, 1% of the population approximately
• it causes a nonsuppurative proliferative synovitis that frequently progresses to
destroy articular cartilage and underlying bone with resulting disabling arthritis
• when extraarticular involvement develops- for example, of the skin, heart, blood,

vessels, muscles and lungs- RA may resemble lupus or scleroderma

RA: LESS= loss of joint space, erosion, swollen inflamed synovial membrane, soft
bone-osteomalacia

INFLAMED

Inflammation of the pleura

nodules
felty syndrome
loss of saliva
anaemia of chronic disease
median nerve problems
eye- scleritis
deposition of amyloid

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