OSTEOARTHRITIS (OA)

Rogelio A Balagat MDASMPH

Assignment:

1. Age2. Weight & height (BMI)3. Joint pain (VAS)4. Joint deformity

Definition of OA

Joint failure•failure of protective mechanisms •cartilage loss •subchondral bone changes •osteophytes •capsule stretching •mild synovitis•periarticular muscle weakness

JOINT INJURY

JOINT REPAIR

-OA +OA

FAILURE OF PROTECTIVE MECHANISMS

WEIGHT-BEARING

Main joint protector

Cartilage•Avascular•Aneural•Load-bearing•Low friction

Joint protectors

•Joint fluid lubrication•Muscle-skin sensory afferent nerve mechanoreceptors•Muscle-tendon co-contraction•Subchondral bone shock-absorption

CATABOLISM SYNTHESIS

CHONDROCYTE

↑AGE PREVIOUS DAMAGE↑WEIGHT

PRIMARY OA• aging bone & cartilage• mechanical factors accumulated microtrauma lower limb malalignment• genetic factors

SECONDARY OA • mechanical joint incongruity congenital, genetic, developmental disorders prior joint trauma/surgery• prior inflammatory joint disease• bleeding dyscrasia• neuropathic joint disease• excessive intra-articular steroid injections• endocrinopathies & metabolic disorders acromegaly Cushing’s disease gout/pseudogout

•Chronic•>40, F>M, ↑weight•Non-inflammatory•DIP, CMC1, Knee, Hip•Use-related pain onset of movement after activity improved with rest

•Bouchard’s nodes (PIP)•Heberden’s nodes (DIP)•“squared-off” base of thumb •malalignment

•swelling•crepitus

KNEE OAHAND OA

HIP OA• pain in groin or inner thigh• antalgic gait, limited/loss of flexion, extension, rotation• predisposing conditions congenital hip dysplasia, avascular necrosis

SPINE OA apophyseal joints, disc/vertebral bodies (spondylosis)

• paraspinal pain, spasm• radicular symptoms cervical neck pain, radiates to shoulder, upper back, distal arm weakness, paresthesias of hand, arm

SPINE OAlumbar low back pain, radiates to buttocks, legs, feet cauda equina syndrome neurogenic claudication• cord compression- leg weakness; gait, balance problems• mechanical compression of vital structures- dysphagia, cough, headache, vertigo

Radiography

Bone formation(-) bone erosion

DIFFERENTIAL DIAGNOSIS

•Rheumatoid Arthritis Monoarticular Polyarticular •Spondyloarthropathies Psoriatic arthritis Reactive arthritis Inflammatory bowel disease Ankylosing spondylitis

DIFFERENTIAL DIAGNOSIS

•Crystal-induced arthritis Gout•Other disorders infectious arthritis periarticular tendenitis or bursitis•Rare neoplastic synovitis pigmented villonodular synovitis neoplastic metastasis to juxta-articular bone

PHARMACOLOGIC NON PHARMACOLOGIC

SURGICALINTERVENTION

Considered as theCORNERSTONE in the

Management of OA

Considered as

ADJUNCTS to Non-pharmacologic

Management

Management

NON PHARMACOLOGIC

Psychosocial Interventions

Patient Education

Physical Modalities

Thermal Modalities

Exercise

Supportive Devices

Modifications in ADL

Psychosocial Measures

PHARMACOLOGIC

Topical Agents

Intra-articular Agents

Oral (Systemic) Agents

Symptom Modifiers

Potential Disease Modifiers

Thanks