UCL School of Pharmacy

PHAY 0011: BST 4

Osteoarthritis
 Osteoarthritis

qExtremely common, associated with age:-

Ø50% affected by age 65 in at least one joint

Ø10% with loss of function (disability)

 Osteoarthritis

Muscle

Bone
Synovium
Lubricant
cartilage Capsule

Bone

Ligament Tendon

Normal joint
 Osteoarthritis

Osteophyte
formation

Bone
Cartilage Synovium
rough and thickened and
thinning slightly inflamed
Bone

Narrowed
joint space Capsule
thickened and
stretched

Arthritis
 Osteoarthritis

Angulation
Exposure of subchondral bone
of bone
® eburnation & cyst formation

Bone
Little
cartilage
remaining
Bone

Advanced arthritis (deformed joint)

Calcification (Ca pyrophosphate deposits in synovium) = ‘pseudogout’
 Osteoarthritis - pathogenesis
qNot fully understood (recurring theme…)

ØJoint (over)use (abnormal ‘wear and tear’)

ØMuscle weakness (esp. in elderly)
ØObesity
ØGenetic predisposition

qSymptoms and signs vary from patient to patient

ØStiffness (start or end of day)

ØPain
ØCreaking or crackling of affected joint (crepitus)
ØVisible remodelling of joint
ØSymptoms gradually worsen OR can plateau

Non-pharmacological treatment ‘individual’

(ie rest if rest helps, exercise if exercise helps)
 Heberden’s and Bouchard’s nodes

Heberden’s nodes

Bouchard’s nodes

Source: Frewin et al. (1997) BMJ 314:360 314 360

 Osteoarthritis - treatment

q Non-pharmacological

q Paracetamol (± weak opioid, though not ideal)

q NSAIDs (non-selective or COX2 selective)

q Topical NSAIDs
q Topical capsaicin
q Supplements (e.g. glucosamine)

q Intra-articular steroids (care: septic arthritis, avascular necrosis)

q Surgery
 Dietary supplementation

qGlycosaminoglycans
OH q Chondroitin: cartilage
q Hyaluronic acid: synovial fluid
O and cartilage

qMixed evidence of efficacy in OA

OH OH OH qNot recommended
q Radiographical changes?
NH2 q Evidence of any effect is weak
q Need to consider shellfish allergy
Glucosamine
UCL School of Pharmacy

PHAY 0011: BST 4

Thank you!