OSTEOARTHRITIS

DEFNITION

OA is a degenerative disease of synovial joints characterised by focal loss of articular hyaline cartilage with proliferation of new bone and remodeling of joint contour

 It is (inflammation) is a misnomer and there is no inflammation here and is a degenerative disease

·         occurs mainly in weight bearing joints like knee, hip

·         occurs mainly in age >65 yrs

·         more common in women

·         increased risk for those with family history

Main clinical features

Ø  pain

Ø  morning stiffness <30 mins

Ø  restricted functionality

ETIOLOGY

Ø  PRIMARY / IDIOPATHIC: When there is no obvious predisposing factor. Common form of OA.

o   Cause –Unknown

§  Common-in elders where there is no previous pathology. Its mainly due to wear and tear changes occuring in old ages mainly in weight bearing joints.

Ø  SECONDARY: When degenerative joint changes occur in response to a recognizable local or systemic factor.

Secondary OA  is due to  predisposing cause such as:

1.Injury to the joint

2.Previous infection

3.RA

4.CDH

5.Deformity

6.Obesity

7.hyperthyriodism

Primary OA ; more common than secondary OA

CLINICAL FEATURES OF OSTEOARTHRITIS

OA  can occur in any joint. commonly seen in hip and knee joint

one or few joints usually involved

Ø  PAIN - increase during movement

Ø  STIFFNESS -

•  Morning stiffness less than 30 minutes
• Stiffness also after prolonged period of inactivity

Ø  SWELLING - of affected joint

Ø  DEFORMITY -  genu varum in case of knee OA

Ø  CREPITUS - grating sensation on moving a joint

Ø  LOSS OF RANGE OF MOTION - due to osteophyte formation ,capsular thickening

RISK FACTORS

Ø  Age :  Age is the most potent risk factor for OA  OA is rare in under age 40  OA occurs in more than 50% of persons over age 70

Ø  Gender :  In general, arthritis occurs more frequently in women than in men. Before age 45, OA occurs more frequently in men; after age 45, OA is more common in women. OA of the hand is particularly common among women.

Ø  Hereditary Gene defect : A defect in one of the genes responsible for the cartilage component collagen can cause deterioration of cartilage.

Ø  Joint’s Abnormalities :  People with joints that move or fit together incorrectly, such as bow legs, a dislocated hip, or double- jointedness, are more likely to develop OA in those joints.

Ø  Obesity : Being overweight during midlife or the later years is among the strongest risk factors for OA of the knee

Ø  Joint overuse or injury  : Traumatic injury (ex. Ligament or meniscal tears) to the knee or hip increases your risk for developing OA in these joints. Joints that are used repeatedly in certain jobs may be more likely to develop OA because of injury or overuse

XRAY FINDINGS

Ø  JOINT SPACE NARROWING

Ø  OSTEOPHYTE FORMATION

Ø  SUBCHONDRAL SCLEROSIS

Ø  LOOSE BODIES WITHIN JOINTS

Ø  CYST FORMATION IN CORTICAL BONE

LAB FINDINGS

Ø  ESR, CRP - normal

Ø  RA factor, anti CCP – negative

TREATMENT PRINCIPLES

EDUCATION

Ø  Nonsystemic nature of disease

Ø  Prevent overloading of joint. Obesity!!

Ø  Appropriate use of treatment modalities

·         Importance of exercise program

·         Aids, apliances, braces

·         Medial treatments

·         Surgical treatment

EXERCISE

Ø  Important for cartilage nutrition

Ø  Some evidence that lack of exercise leads to progression of OA

Ø  Encourage full range low impact movements eg swimming, cycling

Ø  Avoid ;  

§  Prolonged loading

§  Activities that cause pain

§  Contact sports

§  High impact sports eg running

Quadriceps exercises for knee OA

Quadriceps exercises are of proven value for pain relief and improving function, and everyone with knee OA should be taught the correct techniques and encouraged to make these exercises a lifetime habit.

Use of trans cutaneous electrical  nerve stimulation

TENS as an adjunct to other therapy for pain relief at the knee joint .The use of acupuncture, TENS and other local techniques to aid pain relief in difficult cases of OA is often worthwhile.

AIDS AND APPLIANCES

Ø  Braces / splints

Ø  Special shoes/insoles

Ø  Mobility aids

Ø  Aids: dressing, reaching, tap openers, kitchen aids

Ø  Taping of patella in patello femoral OA

Use of a cane, stick or other walking aid. This patient ,who has hip OA, has found that she can reduce the pain in her damaged left hip by leaning on the stick in the right hand as she walks. The reduction in loading can be huge, and the effect on symptoms and confidence with walking very beneficial.

The use of shoes and insoles to reduce impact loading on lower limb joints. Modern sports shoes (‘trainers’)often have appropriate insoles. Alternatively, special heel or shoe insoles of sorbithane or viscoelastic  materials can be used. They may help relieve pain as well as reducing the peak impact load on the joints during walking.

MEDICAL TREATMENT

Ø  Simple analgesics: paracetamol , low dose ibuprofen

Ø  NSAID’s/Coxibs PRN regular

Ø  Intra-articular corticosteroids

Ø  Topical treatment  eg :  NSAID creams, capsaicin

Ø  ‘Chondroprotective agents’

SURGICAL TREATMENT  : Joint replacement surgery