ETIOPATHOGENESIS AND CLINICAL FEATURES OF OSTEOARTHRITIS

DR.S.M. Muhammad Thahir MBBS., DNB(ORTHO).,

OSTEOARTHRITIS
Degenerative joint disease or wear and tear arthritis. Progressive loss of cartilage with remodeling of subchondral bone and progressive deformity of the joint. Cartilage destruction may be a result of a variety of etiologies.

RISK FACTORS

CLASSIFICATIONS:

Pathological Features
Progressive damage of Articular Cartilage. Subchondral Bone Exposed Subchondral sclerosis Subchondral Cyst Repair of Damage (Osteophyte)

PRIMARY OSTEOARTHRITIS
Chronic degenerative disorder related to AGE Cartilage matrix has increased water content and decreased proteoglycan

This is different from the changes that occur with aging cartilage dries up. Increased activity of proteinases compared to inhibitors of proteinases.

CELLULAR LEVEL
Breakdown products of cartilage cause inflammatory reaction of synovium

Cytokines cause matrix degeneration. Where do they come from? chondrocytes Cycle of destruction starts . The body goes to work repairing the damage but the repair is inadequate resulting instead in growth of new bone along the side of the existing bone.

Bony proliferations at joint margins form, what are they called? osteophytes Thought to be new bone formation in response to degenerating cartilage. They cause joint motion restriction

Overview of the process

Articular cartilage gets disrupted

Damage progresses deeper to subchondral bone.

Left: View of normal elbow cartilage through an arthroscope - white, glistening, smooth Right: severe elbow osteoarthritis - cartilage is lost and the bone underneath is exposed

Fragments of cartilage released into joint

Matrix degenerates

Eventually there is complete loss of cartilage and complete loss of bone.

commonly affects the hands, feet, spine, and the large weight bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected.

CLINICAL FEATURES
Unlike other systemic forms of arthritis, Osteoarthritis does not affect the other organs of the body. Symptoms vary greatly from patient to patient, but the most common early symptom is pain in the affected joint or joints. Pain in affected joints Source: Without cartilage, bones rub directly against each other when the joint moves. This is what causes the pain and inflammation.

Other sources of Pain

Joint effusion and stretching of the joint capsule Inflammation of periarticular bursae

Torn menisci

Periarticular muscle spasm

Psychological factors

Pain in the Joint

Slow in onset. Pain may be worse in the morning and feel better with activity. Vigorous activity may cause pain to flare up.

Occurs at rest with advanced disease. May be referred eg hip pain referred to the thigh, groin, knee. Pain may be aggravated with weather changes

OTHER SYMPTOMS
Stiffness , more pronounced in the morning and relieved by bending the Knee. Swelling of the Joint.

Limitation in the motion of the Joint. Difficulty in Squatting , Sitting Leg crossed and going stairs

Examination:
Joint line tenderness. Joint line pain can indicate tear of the lining of the capsule or the meniscus. Bony enlargement of joint +/- effusion Crepitus Decreased range of motion

 In the evaluation of joint line pain, perform a varus or valgus stress test. Apply stress across the joint, place fingers directly over the joint line to assess for pain, a clunk may indicate a meniscal tear, or crepitus may indicate cartilage damage.

 Have the patient lie supine with leg muscles relaxed Compress the suprapatellar pouch with your thumb, palm, and index finger. "Milk" downward and laterally so that any excess fluid collects on the medial side. Tap gently over the collected fluid and observe the effect on the lateral side A fullness on the lateral side indicates the presence small knee effusion

Deformity of the Joint in Advanced cases.

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