Degenerative Joint Diseases

8/8/2019 Degenerative Joint Diseases

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Degenerative Joint Diseases:Degenerative Joint Diseases:

OsteoartritisOsteoartritis

Manal Y TayelProf OF Internal Medicine And

Rheumatology

2009-2010.

DefinitionDefinition Osteoarthritis (OA) is the leading cause

of arthritis in the adult American

population and affects an estimated 20million people in the United States.

Joint pain is a frequent symptom that

often prompts a patient to seek medical

attention

Synonymous with degenerative joint

disease.

Essentials of DiagnosisE

ssentials of Diagnosis Joint pain brought on and exacerbated by

activity and relieved with rest.

Stiffness that is self-limited upon

awakening in the morning or when rising

from a seated position after an extended

period of inactivity. Absence of prominent constitutional

symptoms.

Clinical PresentationC

linical Presentation Characteristic sites of involvement in the

peripheral skeleton include the hand (distal

interphalangeal joint, proximal interphalangeal joint, and first carpometacarpal joint]), knee andhip .

Constitutional symptoms are absent

Erythrocyte sedimentation rate normal for age. Non-inflammatory synovial fluid (<1000

WBC/mm3)

Clinical PresentationC

linical Presentation Negative serologic tests for antinuclear

antibody and rheumatoid factor

Radiographic evidence of osteoarthritis(non-uniform joint space narrowing,

osteophyte [spur] formation,subchondral cysts, and eburnation[bony sclerosis])

adiograph of a hand showingRadiograph of a hand showing

osteoarthritis of the distalosteoarthritis of the distalinterphalangeal (DIP),interphalangeal (DIP),

proximal interphalangeal (PIP), proximal interphalangeal (PIP),

and first carpometacarpaland first carpometacarpal

(CMC) joints. Note the joint(CMC) joints. Note the joint

space narrowing of the DIPspace narrowing of the DIPand PIP joints compared to theand PIP joints compared to the

metacarpophalangeal joints, asmetacarpophalangeal joints, as

well as the bony sclerosiswell as the bony sclerosis

(eburnation) of all joints(eburnation) of all joints

involved by the osteoarthritisinvolved by the osteoarthritis

process. process.

The base of the

first finger with

OA affection of

the CMC joint

K nee osteoarthritis with medial joint spaceK nee osteoarthritis with medial joint space

narrowing and osteophytes.narrowing and osteophytes.

OA of the hip joints

Factors That Predispose Persons To OA.Factors That Predispose Persons To OA.

Age, gender and race, joint injury, andObesity

Age: Although the clinical manifestations of OA can begin

as early as the fourth and fifth decades of life, theincidence of OA continues to increase with each decade of aging.

Gender : Women in their 50s, 60s, and 70s have a greater prevalence of OA in the hands and knees than do men.

Race: There is evidence that OA among African Americansis more severe and has greater impact on disability than inwhites.

Risk factors for OARisk factors for OA

Trauma: to a joint such as a ruptured anterior cruciate ligament or torn meniscus increases

the risk of later osteoarthritis. Obesity: women and men are at high risk of

knee osteoarthritis and have a modest increasein hip OA risk. This increase in risk is due

mostly to the excess load across weight-bearing joints conferred by obesity, and at least for women, the risk is proportional to the degree of

overweight.

Causes Of Causes Of OsteoarthritisOsteoarthritis

1- Primary

2- Secondary

Congenital disorder (hip) : Legg-Calvé-Perthes

disease, Acetabular dysplasia , Slipped capital femoralepiphysis

Inborn error of connective tissue : Ehlers-Danlossyndrome, Marfan syndrome

Post traumatic (knee): Anterior cruciate ligament

tear, Meniscus tear . Metabolic disorders : Hemochromatosis , Wilson disease

History of a septic joint: Post-inflammatory

Underlying rheumatoid arthritis

TreatmentTreatment

The goals of medical therapy are to:

1- control pain

2- improve function

3- minimize disability

4- enhance health-related quality of life.

Non Non--pharmacologic Treatments pharmacologic Treatments

They have demonstrated efficacy and can often

help relieve pain and improve function. For

example, an assistive device, such as a properly-

used cane or walker, can unload an affectedknee or hip and diminish pain with walking.

Similarly, quadriceps strengthening and aerobic

exercise are effective in the management of

osteoarthritis at the knee. For exercise therapy,referral to a physical therapist is often helpful,

as they will evaluate function and craft the right

mix of exercises.

Weight loss should be encouraged for all persons

with knee or hip osteoarthritis.Pharmacological Treatment:

A front-line approach to medicinal therapy for osteoarthritis includes use of acetaminophen. This

drug improves pain and function and has a safer toxicity profile, particularly with regard to thegastrointestinal tract, than NSAIDs.

NSAIDs have been widely used in the management

of OA. Via their inhibition of cyclooxygenase,symptomatic benefit is achieved. NSAIDs aremodestly more efficacious than acetaminophenfor the pain of osteoarthritis.

Ways To Diminish NSAIDWays To Diminish NSAID ToxicityToxicity

Gastroprotective drugs especially proton

pump inhibitors

Administration of cyclooxygenase-2

isoenzyme inhibitors ( recent forms of

NSAIDs ) reduces GIT upset, but has no

effect on renal toxicity.

TreatmentTreatment

The efficacy of glucosamine sulfate in the

medical management of osteoarthritis is

controversial. Glucosamine sulfate is acomponent of human articular cartilage

that is administered orally.

TreatmentTreatment

Chondroitin sulfate (also commerciallyavailable) is similarly controversial.

TreatmentTreatment Intra-articular hyaluronic acid is a

controversial FDA-approved

treatment for knee OA.

Future DirectionsFuture Directions

Biomechanical TreatmentsBiomechanical Treatments

The aim is to identify biomarkers²of bone

and cartilage turnover²that may identifythose at risk for osteoarthritis and those

at risk for disease progression.

In the future, availability of drug therapy

that may inhibit the adverse effects of

degradative enzymes or promote the

growth of deficient cartilaginous.

Degenerative Joint Diseases

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