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Discussion Osteoarthritis

Medical Doctor (Universiti Putra Malaysia)

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DISCUSSION

Osteoarthritis (OA) is a chronic joint disorder in which there is progressive softening and
disintegration of articular cartilage. It is the commonest form of arthritis. Autopsy studies show
everyone above 65 years, 50% have osteoarthritis changes. Both gender have equal likelihood to
develop this condition. However, the disease becomes more common in women after age 55
years. Female have higher prevalence of OA of the knees and hands, whereas males have a
higher prevalence of OA of the hips.

Risk factors of OA include advanced age, gender, family history, obesity, occupation, trauma or
fracture involving the articular surface, and joint dysplasia. Osteoarthritis predominantly
involves the weight-bearing joints, including the knees, hips, cervical and lumbosacral spine, and
feet. Other commonly affected joints include the distal interphalangeal (DIP) and proximal
interphalangeal (PIP) joints of the hands.

A 51 years old obese lady, presented with unilateral, chronic left knee pain for 3 years duration.
Her age, gender and BMI are the risk factors of developing osteoarthritis (OA).

Based on the history taking, unilateral pain is the most important symptom of OA as compared to
symmetrical joint involvement in rheumatoid arthritis (RA) . The site of pain was at the knee
joint which is the weight-bearing joint that commonly involve in OA. The pain was also
worsened with activities and relieved by rest. Other symptom like morning stiffness can also be
part of the presentation of OA, which is brief and localized, with duration less than 30 minutes.
RA can also be presented with early morning stiffness, however the duration is longer which is
more than 1 hour presentation.

On physical examination, patient may presented with antalgic gait due to painful knee joints.
Secondary genu varus deformity very suggestive of OA as compared in RA, more likely to
develop genu valgus deformity. Inflammatory changes was noted : swelling, tenderness and
warm over the affected knee. Limitation of movement was also noted due to pain experienced by
the patient.

The definite diagnosis of OA is established by plain x-ray of affected joint (antero-posterior and
lateral view). The characteristic features of OA in x-ray are narrowing of joint space, presence of
osteophytes, subchondral cyst and subchondral sclerosis. As in this patient, the x-ray of affected
knee joint showed classical sign of OA.

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The principle of management in patient with OA is to alleviate the pain, improve the functional
status, and reduce load as well as to prevent disability. The treatment is divided into conservative
and operatively. Conservative treatment includes pharmacologic and non-pharmacologic
intervention. Non pharmacology includes education to patients regarding the disease, advised on
weight reduction, avoids weight bearing activities like squatting, climbing stairs and prolong
standing. Physiotherapy includes quadriceps muscle-strengthening exercise, pain relief, and
improves muscle function and range of motion. Pharmacologic intervention includes analgesic
drugs and intra-articular injection. Surgery is indicated to those who have significant symptoms
that fail to respond to conservative treatment. There are various surgical treatments available,
which include arthroscopy with debridement, realignment osteotomy and total knee arthroplasty.

REFERENCES

1. Louis Solomon, David J. Warwick, Selvadurai Nayagam. Apley’s System of Orthopaedic

and Fractures. Hodder Arnold. 2005.
2. http://emedicine.medscape.com/article/330487

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