OSTEOARTHRITIS

IMAGING
Kelompok 5
 ANGGOTA KELOMPOK :
• Agus Triwikrama Putra 15700051
• Gede Utama Diatmika Putra 15700053
• I Gede Wahyu Terra Pranata 15700055
• Putu Septia Kartika Putri 15700057
• Putu Eka Widyantara 15700059
 INTRODUCTION
Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis (OA)
is the most common chronic condition of the joints, affecting approximately 27 million
Americans. OA can affect any joint, but it occurs most often in knees, hips, lower back and
neck, small joints of the fingers and the bases of the thumb and big toe. In normal joints, a
firm, rubbery material called cartilage covers the end of each bone. Cartilage 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.
 OSTEOARTHRITIS
Osteoarthritis (OA) is a long-term chronic disease characterized by the deterioration of
cartilage in joints which results in bones rubbing together and creating stiffness, pain, and
impaired movement. The disease most commonly affects the joints in the knees, hands, feet,
and spine and is relatively common in shoulder and hip joints. Osteoarthritis is a degenerative
joint disease, which mainly affects the articular cartilage. It is associated with ageing and will
most likely affect the joints that have been continually stressed throughout the years including
the knees, hips, fingers, and lower spine region.
 CASE REPORT
• A 73-year-old man had been visiting our institution for 3 years since April 2011 for bilateral
knee pain. His height was 157.4 cm his body weight was 59.0 kg. He had no serious past
medical history. Clinical examination revealed the range of motion (ROM) of the bilateral
knees to be as follows: flexion and extension in the right and left knee were 120 and −20
degrees and 130 and −20 degrees, respectively. Plain radiographs showed Kellgren and
Lawrence (KL) grading II in the right knee joint, localized bone formation at the proximal
lateral tibia, and a bone cyst in the middle of the proximal tibia plateau at the initial visit (
Figure 1a). As conservative treatment, non-steroidal anti-inflammatory drugs (NSAIDs)
were prescribed and right knee puncture was performed periodically for pain management.
• Figure 1
• Figure 2
• Figure 3
• Plain radiograph at the first visit shows KL grading II in the right knee. Subchondral sclerosis,
osteophytes, and joint space narrowing at the medial joint are evident. A large bone cyst (black
arrow) is observed on the middle of the proximal tibial plateau. Localized bone formation in the
proximal lateral tibia is apparent (white arrow). b, c) Broad low-intensity area by T1W and high
intensity area by STIR in the medio-central femur and tibia are observed.
• MRI of his right knee revealed broad bone signal changes by T1W and STIR in the distal-
medial femur and proximal-mediocentral tibia (Figure 1b, c). As described previously (3, 4),
bone signal changes were judged to be present only when they were detected by both T1W and
STIR.
• During the observation period, the size of the patient’s localized bone formation at the proximal
lateral tibia changed constantly (Figures 1a, ​,2a,2a, ​,3a),3a), but his severe knee pain soon
subsided following therapeutic measures.
 DIFFERENTIAL DIAGNOSIS
• Rheumatoid Arthritits
• Osteoarthritis
 TREATMENT
• Non Pharmacology
• Physical training
• Weight loss
• Braces and patellar taping
• Acupunture
• Pharmacology
• Drug use is carried out if with non-pharmacological therapies cannot overcome existing
symptoms. Frequent medicines doctors use include :
• Nonsteroidal anti-inflammatory drugs (NSAIDs), Cyclooxygenase-2 (COX-2) inhibitors and
acetaminophen.
• Hyaluronic acid injection
• Glucosamine and chondroitin sulfate
• Other pharmacological therapies
• The updated AAOS guidelines provide specific recommendations for various treatment
options; however, clinicians must determine which options are appropriate for each patient.
An inconclusive recommendation in the guidelines does not preclude the provider from
using these treatment options when appropriate. Specifically, the recommendation against
the use of hyaluronic acid injections can create a treatment dilemma, especially for patients
who cannot tolerate anti-inflammatory medications. Because hyaluronic acid injections vary
in formulation and effect, ongoing evaluation of their effectiveness is important.
• The change in recommendation against acetaminophen and for the use of tramadol for pain
control likely will affect treatment patterns in primary care and orthopedic offices, with
increased reliance on NSAIDs. Primary care providers have much to offer in the team
approach to the management of knee osteoarthritis. Understanding current treatment
recommendations, along with appropriate imaging and experience evaluating painful knees,
will help providers manage symptomatic knee osteoarthritis and know when to refer patients
to orthopedicspecialists.
 REFERENCES
• Sasek,2015. An update on primary care management of knee osteoarthritis Journal of the
American Academy 28 (1) 
• Herrlin SV, Wange PO, Lapidus G, et al. Is arthroscopic surgery beneficial in treating non-
traumatic, degenerative medial meniscal tears 2013;21(2):358–364.
• Masatoshi Komatsu, et all .2014. Rapid bone destruction in a patient with knee osteoarthritis. A
case report and review of the literature 11(3)
• Kamimura M, Nakamura Y, Ikegami S, Mukaiyama K, Uchiyama S, Kato H. The
Pathophysiology of Primary Hip Osteoarthritis may Originate from Bone Alterations. Open
Rheumatol J. 2013;7:112–8.
• Li G, Yin J, Gao J, Cheng TS, Pavlos NJ, Zhang C, Zheng MH. Subchondral bone in
osteoarthritis: insight into risk factors and microstructural changes. Arthritis Res
Ther. 2013;15:223.