OSTEOARTHRITIS

DEFINITION- joint failure, a disease in which all structures of the joint have undergone
pathologic change, often in concert. The pathologic sine qua non of disease is HYALINE
ARTICULAR CARTILAGE LOSS present in a focal and, initially, nonuniform manner. This is
accompanied by increasing thickness and sclerosis of the subchondral bony plate, by outgrowth
of osteophytes at the joint margin, by stretching of the articular capsule, by mild synovitis in
many affected joints, and by weakness of muscles bridging the joint. In knees, meniscal
degeneration is part of the disease. There are numerous pathways that lead to joint failure, but the
initial step is often joint injury in the setting of a failure of protective mechanisms.

-the most common type of arthritis. Its high prevalence, especially in elderly, and the high rate of
disability related to disease make it a leading cause of disability in the elderly.

-OA affects certain joints, yet spares others. Commonly affected joints include the cervical and
lumbosacral spine hip, knee and first metatarsal phalangeal joint (MTP).

- In the hands, the DISTAL and PROXIMAL INTERPHALANGAL JOINTS and the BASE of
the THUMB are often affected.

-usually spared are:

 Wrist
 Elbow
 Ankle
We thus develop OA in joints that were ill designed for human tasks such as pincer grip and
walking upright. Some joints like the ankles may be spared because their articular cartilage may
be uniquely resistant to loading stresses.

PATHOGENESIS:
The lesions of OA stem from degeberation of the articuolar cartilage and its disordered repair.
The articular cartilage contributes to the virtually frictionless movement of the joint while
providing resistance to tension and compression, from type II collagen and proteoglycans,
respectively both synthesized by chondrocytes.
The chondrocytes can be divided into 3 phases:
 1. Chondrocyte injury, reated to genetic and biochemical factors
2. Early OA, in which chondrocytes proliferate and secret inflammatory mediators,
collagens, proteoglycans, and proteases, which act together to remodel the cartilaginous
matrix and initiate secondary inflammatory changes in the synoviu and subchondral bone
3. Late OA, in which repetitive injury and chronic inflammation lead to chondrocyte drop
out, marked loss of cartilage, and exyensive subchonral bone changes.

CLINICAL FEATURES:
Joint pain from OA is activity-related. Pain comes on either during or just after joint use and then
gradually resolves.

Signs and symptoms:

Symptoms of osteoarthritis include the following:

 Deep, achy joint pain exacerbated by extensive use - The disease’s primary symptom
 Reduced range of motion and crepitus - Frequently present
 Stiffness during rest (gelling) - May develop, with morning joint stiffness usually lasting
for less than 30 minutes
Osteoarthritis of the hand
 Distal interphalangeal (DIP) joints are most often affected
 Proximal interphalangeal (PIP) joints and the carpometacarpal (cmc) joints at the base of
the thumb are also typically involved
 Heberden nodes, which represent palpable osteophytes in the DIP joints, are more
characteristic in women than in men
 Inflammatory changes are typically absent, less pronounced, or go unnoticed

***early in disease, pain is episodic, triggered often by a day or two of overactive use of a
diseased joint. As disease progresses, the pain becomes continuous and even begins to be
bothersome at night. Stiffness of the affected joint may be prominent, but morning stiffness is
usu. Brief (<30 min).
DIAGNOSTIC TEST
 Joint aspiration
 X-ray
 MRI
TREATMENT:
Goal: to alleviate pain and minimize loss of physical function.
NONPHARMACOTHERAPY:
 Avoiding activities that overload the joint
 Improving the strength and conditioning of muscles that bridge the joint
 Unloading the joint, either by redistributing load within the joint with a brace or a splint
EXERCISE
Correction of malalignment
Pharmacotherapy:
 Acetaminophen, NSAIDs, and COX-2 Inhibitors
 Intraarticular injections: glucocorticoids and hyaluronic acid
SURGERY
 Tibial osteotomy
 Total knee or hip replacement
 Cartilage regeneration

Genisa A. Gumansing