Osteoarthritis

Dr Shahzeb khan (PT)

Osteoarthritis
• Osteoarthritis most common form of arthritis and common joint
disease.
• Sometimes called degenerative joint disease or “wear and tear”
arthritis.
• Most people who have OA are older than 45 & women more
commonly affected than men.
• Its greatest impact is on weight-bearing joints e.g. hips and knees.
• There are no extra-articular features and no systemic illness
Etiology
• Age
• Hereditary
• Obesity
• Joint alignment
• Traumatic injury
Classification
• PRIMARY AND SECONDARY OSTEOARTHRITIS:
• Primary OA:
• Idiopathic
• Common in elders when there is no previous pathology
• Mainly due to wear and tear changes in old ages commonly in weight bearing joints.
• Secondary:
• Due to predisposing factors as:
• Injury to joint
• Infection
• Deformity
• Obesity
Mechanism
• normal joints ,cartilage covers the end of each bone.
• Provides a smooth, gliding surface for joint motion and acts as a cushion between
the bones.
• In OA, the cartilage breaks down, causing pain, swelling and problems moving the
joint.
• As OA worsens over time, bones may break down and develop growths called spurs.
• Bits of bone or cartilage may chip off and float around in the joint. In the body, an
inflammatory process occurs and cytokines (proteins) and enzymes develop that
further damage the cartilage.
• In the final stages of OA, the cartilage wears away and bone rubs against bone
leading to joint damage and more pain.
INCREASE Cartilage Bone spurs Inflammatory Degeneration
Stresses breakdown formation response
PATTERN OF JOINT INVOLVEMENT
• Nodal osteoarthritis:
• Nodal osteoarthritis occurs predominantly in middle - aged women
presenting with bony swelling of distal interphalangeal joint
Heberden’s nodes), swelling of proximal interphalangeal joint
(Bouchard’s nodes). The onset may be acute with severe pain,
swelling and inflammation.
• Non-nodal osteoarthritis:
• It is less prominent in distal interphalangeal joint.
• Erosive osteoarthritis:
• It is severe osteoarthritis presenting with episodic signs and
symptoms of joint inflammation with development of destructive
subchondral erosions in proximal and distal interphalangeal joints.
• Osteoarthritis of knees:
• It is often associated with obesity and is more common in women
CLINICAL FEATURES
• The joints most frequently involved are those of spine, hips, knees and
hands. The disease is confined in one or only a few joints in the
majority of patients.
• Symptoms
• Pain:
• Typically in the knees, hip, hands.
• Worst in the evening.
• Aggravated by use and relieved by rest.
• Intermittent at first but later chronic.
• Morning stiffness :
• Usually lasting up to half an hour, stiffness also after sitting.
• Disability:
• Movement in the affected joints becomes increasingly limited, initially
as a result of pain and muscular spasm, but later because of capsular
fibrosis, osteophyte formation and remodeling of bone.
• Signs
• Joint swelling :
• Characteristically hard and bony sometimes with associated effusion.
• Crepitus :
• On movement may be felt or even heard.
• Muscle wasting:
• Wasting of the muscles around the affected joints.
• Joint deformities :
• Particularly in knee joint. Valgus (outward) or varus (inwards) or flexion deformities are
seen with instability of the joint due to absence of normal muscular control as a result
of muscle wasting.
DIFFERENTIAL DIAGNOSIS
• Osteoarthritis
• Distal interphalangeal joint involvement
• Number of joints involved is less.
• Rheumatoid arthritis
• Proximal interphalangeal metacarophalangeal joints involvement
• Number of joints involved is more.
INVESTIGATION
• A diagnosis of osteoarthritis may be suspected after a medical history
and physical examination is done. Blood tests are usually not helpful
in making a diagnosis. However, the following tests may help confirm
it:
• Joint aspiration. The doctor will numb the affected area and insert a
needle into the joint to withdraw fluid. The fluid will be examined for
evidence of crystals or joint deterioration. This test can help rule out
other medical conditions or other forms of arthritis.
• X-ray:
• Narrowing of the joint space: due to loss of the cartilage.
• Formation of osteophytes at the margin of the joints.
• Sclerosis of the underlying bone.
• Cyst formation.
• MRI. Magnetic resonance imaging (MRI) does not use radiation. It is more
expensive than X-rays, but will provide a view that offers better images of cartilage
and other structures to detect early abnormalities typical of osteoarthritis
• Blood test:
• Blood count & ESR are characteristically normal.
Treatment
• Osteoarthritis is a chronic (long-term) disease. There is no cure,
but treatments are available to manage symptoms. Long-term
management of the disease will include several factors:
• Managing symptoms, such as pain, stiffness and swelling
• Improving joint mobility and flexibility
• Maintaining a healthy weight
• Getting enough of exercise
• Exercise :
• Strengthening exercises build muscles around OA-affected joints, easing the
burden on those joints and reducing pain. Range-of-motion exercise helps
maintain and improve joint flexibility and reduce stiffness. Aerobic exercise
helps to improve stamina and energy levels and also help to reduce excess
weight.
• Weight Management:
• Excess weight adds additional stress to weight-bearing joints, such as the
hips, knees, feet and back. Losing weight can help people with OA reduce
pain and limit further joint damage. The basic rule for losing weight is to eat
fewer calories and increase physical activity.
• Medication:
• Analgesics. These are pain relievers and include acetaminophen, opioids (narcotics) and an
atypical opioid called tramadol. They are available over-the-counter or by prescription.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). These are the most commonly used drugs
to ease inflammation and related pain. NSAIDs include aspirin, ibuprofen, naproxen and
celecoxib. They are available over-the-counter or by prescription.
• Corticosteroids. Corticosteroids are powerful anti-inflammatory medicines. They are taken
by mouth or injected directly into a joint at a doctor’s office.
• Hyaluronic acid. Hyaluronic acid occurs naturally in joint fluid, acting as a shock absorber
and lubricant. However, the acid appears to break down in people with osteoarthritis.
• Surgery:
• Joint surgery can repair or replace severely damaged joints, especially hips or knees. 
• Thanks