JOURNAL READING

OSTEOARTHRITIS
SUPERVISOR
Dr. Ganda Purba , Sp. OT
ADELA BRILIAN
I 11112020
SMF BEDAH RUMAH SAKIT TK.II KARTIKA HUSADA
FAKULTAS KEDOKTERAN DAN ILMU KESEHATAN
UNIVERSITAS TANJUNGPURA
KUBU RAYA
2016

Introduction
Osteoarthritis (OA) is a chronic degenerative joint disorder

known to be most frequent in the lower extremity,

especially the knee joint, where pathological joint impact
symptoms are pain, a decreased joint range of motion
(ROM) and stiffness, periarticular muscle weakness and
atrophy, joint effusion and swelling, and physical disability.
reduced participation in valued activities and poor quality
of life, are common for individuals with OA

Prevalence
About 13% of women and 10% of men aged 60 years and

older have symptomatic knee OA.

The proportions of people affected with symptomatic knee
OA is likely to increase due to the aging of the population
and the rate of obesity or overweight in the general
population.

Victor V. Christina S. Treatment and Prevention od Osteoarthritis through Exercise and Sports.
SAGE-Hindawi Access to Research Journal of Aging Research,2011(6) doi:10.4061/2011/374653

Risk Factors
Age
Genetic susceptibility
Obesity
Female gender
Trauma
Repetitive knee trauma
Muscle weakness
Joint laxity
Mechanical forces
Kneeling
Squatting

Michael JWP. SChluter-Brust KU. Peer E.The Epidemiology, Etiology, Diagnosis, and Treatment of

Osteoarthritis
of the Knee. Dtsch Arztebl Int 2010; 107(9): 15262 DOI: 10.3238/arztebl.2010.0152

Miniscal injuries

Knee OA

Michael JWP. SChluter-Brust KU. Peer E.The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee. Dtsch Arztebl Int 2010;
107(9): 15262 DOI: 10.3238/arztebl.2010.0152

Pathophysiology

Michael JWP. SChluter-Brust KU. Peer E.The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee. Dtsch Arztebl Int 2010;
107(9): 15262 DOI: 10.3238/arztebl.2010.0152

Current Management
As there is no cure for OA, treatments currently focus on

management of symptoms. Pain relief, improved joint

function, and joint stability are the main goals of therapy.
Current guidelines for the treatment of OA recommend a
combination of pharmacological and non-pharmacological
treatments

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and

Nonpharmacological Interventions. Rheumatology Network; 2012.

SELF-HELP INTERVENTIONS
diet, exercise, and weight loss are associated with

decreased symptom severity and functional improvement

in patients with knee OA
do not have consistent significant effects on biomarkers
reflective of disease progression. However, they have
been shown to significantly decrease levels of
inflammatory markers

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and

Nonpharmacological Interventions. Rheumatology Network; 2012.

Strength Training
Focused strength training (supervised or done at home

unsupervised) has been shown to improve mobility and

decrease pain in patients with knee OA. However,
evidence indicating that it has beneficial effects on knee
OA progression Is limited.

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and

Nonpharmacological Interventions. Rheumatology Network; 2012.

cont
No major difference in effectiveness was reported

between land-based aerobic and strengthening exercise.

Concerning the beneficial effects of aquatic-based
exercise, controversial data exists. In one study, aquatic
exercise has been shown to be less efficient in reducing
pain and improving muscle function than land-based
exercise

Victor V. Christina S. Treatment and Prevention od Osteoarthritis through Exercise and Sports.
SAGE-Hindawi Access to Research Journal of Aging Research,2011(6) doi:10.4061/2011/374653

cont
in case of severe joint pain or in obese patients, the

authors believe that an initial period of water-based

exercise is helpful. As swimming or aqua jogging provides
a muscle workout without joint loading, further pain and
weight-related joint destruction is avoided.

Victor V. Christina S. Treatment and Prevention od Osteoarthritis through Exercise and Sports.
SAGE-Hindawi Access to Research Journal of Aging Research,2011(6) doi:10.4061/2011/374653

Dietary Supplementation
Although the combination of glucosamine and chondroitin

did not achieve statistical significance compared with

placebo for relief of mild knee pain, it did result in
statistically significant pain relief for a small subset of
patients with moderate or severe knee pain.
In the Study on Osteoarthritis Progression Prevention,
patients with knee OA who had a significant reduction in
joint-space width loss than patients who received placebo

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and Nonpharmacological Interventions.
Rheumatology Network; 2012.

 In contrast to the results of these clinical studies,

glucosamine has been reported to double steady-state

levels of aggrecan messenger RNA, to inhibit
aggrecanase activity induced by ILs, and to decrease
nitric oxide production induced by IL-1 and TNF- in
vitro. Glucosamine also has been shown to modulate the
osteoprotegerin-receptor activator of nuclear factor kappa
B (NF-B) ligand ratio in osteoarthritic subchondral bone
osteoblasts and to reduce bone resorption.

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and Nonpharmacological Interventions.
Rheumatology Network; 2012.

 glucosamine and chondroitin have played a significant

role in the management of patients with knee OA. These

agents have minimal adverse effects and, in some
patients, can provide substantial benefit.
There also is evidence to indicate that treatment with
glucosamine can delay the need for joint treatment with
glucosamine or placebo, total knee replacement had been
performed in 14.9% of 131 patients treated with placebo
versus 6.3% of 144 patients who received glucosamine.

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and Nonpharmacological Interventions.
Rheumatology Network; 2012.

Curcumin
Curcumin alone has been shown to inhibit basal and IL-

1stimulated nitric oxide, prostaglandin E2, vIL-6, IL-8,

and MMP-3 production by human chondrocytes in a
concentration-dependent manner. In a study of 107
patients with knee OA who participated in a randomized
trial in Thailand, 500 mg of curcumin administered 4 times
a day was as effective as 400 mg of ibuprofen
administered twice daily for decreasing walking pain.

Vijay B. Stanley HD. Managing Knee Osteoarthritis: Self-Help and Nonpharmacological Interventions.
Rheumatology Network; 2012.

Intra-articular glucocorticoid
When signs of inflammation arise, intra-articular

glucocorticoid injections can very rapidly eliminate a joint

effusion. In a meta-analysis (evidence level Ia) of the
efficacy of intra-articular corticosteroid injections
compared to placebo, hyaluronic acid, and lavage, it was
found that corticosteroid injections significantly reduced
pain two weeks after the injection

Michael JWP. SChluter-Brust KU. Peer E.The Epidemiology, Etiology, Diagnosis, and Treatment of
Osteoarthritis of the Knee. Dtsch Arztebl Int 2010; 107(9): 15262 DOI: 10.3238/arztebl.2010.0152

New Direction for OA theraphy

Targeting Inflamation
Targeted anti-inflammatory agents, such as monoclonal

antibodies against TNF-alpha, have been used in OA

trials, and small open label studies of anti-TNF agents
have shown some effectiveness in painful OA

Claire YJW. Philip GC. New horizons in osteoarthritis. Age and Ageing 2013; 42: 17 doi:
10.1093/ageing/aft043

 Targeting Nerves
as healthy cartilage is aneural. Interestingly, a recent

report suggests that nerve and vascular in-growth

occurs in damaged areas of OA cartilage at the
osteochondral junction
Increased nerve growth factor (NGF) expression is
noted in these vascular channels, which also contain
sensory nerve fibres. NGF may increase the sensory
nerve activity in the subchondral bone, hence offering
a mechanism for both cartilage and subchondral
bone as a peripheral source of pain in OA and may
offer a target for treatment by a novel class of drugs,
the anti-NGFs.
Claire YJW. Philip GC. New horizons in osteoarthritis. Age and Ageing 2013; 42: 17 doi:
10.1093/ageing/aft043

Cont
Tanezumab, is a humanized monoclonal antibody that

binds and inhibits NGF and has demonstrated both good

analgesic efficacy and improvement in function in a study
of 450 people with knee OA
However, the development of anti-NGF drugs is
continuing with rigorous safety criteria included in future
trials. Anti-NGF therapies offer potential as the first new
class of analgesics in many years.

Claire YJW. Philip GC. New horizons in osteoarthritis. Age and Ageing 2013; 42: 17 doi:
10.1093/ageing/aft043

 Targeting Central Pain

As well as peripheral sources of OA pain that may be

targeted for analgesic treatments, there are new

treatments for OA that target central pain in OA. Recently
trialed therapies include centrally acting drugs such as
duloxetine, a serotonin-noradrenaline reuptake inhibitor,
for which there is growing evidence

Claire YJW. Philip GC. New horizons in osteoarthritis. Age and Ageing 2013; 42: 17 doi:
10.1093/ageing/aft043

cont
Short-term (10 week) studies of duloxetine versus placebo

demonstrated a significant improvement in pain and

function for people with painful knee OA already taking
NSAIDs. Duloxetine shows promise as a treatment for OA
pain and for improving function, but the data specific to
OA is currently short-medium term only, however, this
drug was recently approved for use in OA by the FDA.
Side effects of duloxetine included nausea, dry mouth and
constipation, which may limit its use.

Claire YJW. Philip GC. New horizons in osteoarthritis. Age and Ageing 2013; 42: 17 doi:
10.1093/ageing/aft043

 Strontium demonstrated a reduction in jointspace

narrowing compared with placebo over a 3-yearperiod, as

well as an improvement in clinical symptoms .While the
study using calcitonin in 1,200 knees did not show a
difference in reduction in radiographic joint space
narrowing over 2 years, there was an increase in cartilage
volume compared with the placebo

Claire YJW. Philip GC. New horizons in osteoarthritis. Age and Ageing 2013; 42: 17 doi:
10.1093/ageing/aft043

Conclution
Osteoarthritis is the most common type of arthritis worldwide and

a major source of pain and disability.

Optimal
management
requires
a
combination
of
nonpharmacological and pharmacological treatment modalities.
Diet and exercise programs and curcumin supplementation are
effective for decreasing OA symptoms and have been shown to
lower levels of biomarkers thought to be related to disease
activity. Clinical results for glucosamine/chondroitin suggest that
these nutraceuticals may provide protection against joint-space
narrowing in patients who have knee OA
new approaches to targeting pathology offer hope of new
analgesic options and for the first time, structure modification
may be possible by treating a non-cartilage target, the
subchondral bone

 Thank you