4 2 Osteoarthritis 1

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Berniece Watkins
5 years ago
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1 Osteoarthritis 1

Osteoarthritis ( OA) Osteoarthritis is a chronic disease and the most common of all rheumatological disorders. It particularly affects individuals over the age of 65 years.

2 Osteoarthritis ( OA) Osteoarthritis is a chronic disease and the most common of all rheumatological disorders. It particularly affects individuals over the age of 65 years. The prevalence of osteoarthritis increases with age. Women are more likely to have inflammatory OA of the proximal and distal interphalangeal joints of the hands, giving rise to the formation of Bouchards node and heberdens nodes. 2

3 Osteoarthritis was previously thought to be the consequence of aging, thereby leading to the term degenerative joint disease. However, it is now thought to be the result of a complex interplay of multiple factors including genetic predisposition, local inflammation, mechanical forces and cellular and biochemical processes. 3

4 Aetiology Osteoarthritis is a complex disease involving bone, cartilage and the synovium. It is generally believed to be an imbalance in erosive and reparative processes. There are a wide variety of factors predisposing an individual to this condition including the following: Increasing age Gender Genetic predisposition 4

5 Obesity Previous injury either due to sport or occupation Previous disease such as rheumatoid arthritis or gout Systemic disorders such as acromegaly 5

6 Classification of OA OA falls into tow major etiologic classes. Primary (idiopathic) OA, the most common type, has no identifiable cause. Subclasses of primary OA include Localized OA, involving one or two sites. Generalized OA, affecting three or more sites. Secondary OA is that associated with a known cause such as rheumatoid arthritis, obesity, metabolic or endocrine disorders. 6

7 The pathogenesis of osteoarthritis has been classified into four stages: 1- Initial repair is characterized by proliferation of chondrocytes synthesize the extracellular matrix of bone. 2- Early stage osteoarthritis results in degradation of the extracellular matrix as protease enzyme activity exceeds chondrocyte activity. 7

8 3- Intermediate osteoarthritis is associated with a failure of extracellular matrix synthesis and increased protease activity, further increasing cartilage loss. 4- late-stage osteoarthritis may result in complete loss of cartilage with joint space narrowing in the most severe of cases. Bone outgrowths (osteophytes) appear at the joint margins, and there is sclerosis of the adjacent bone. Deformity is common at this stage. 8

9 Clinical manifestations Osteoarthritis is traditionally classified by aetiology into idiopathic and secondary forms. Idiopathic can be further divided into localised and generalised depending on the number of joints involved. Localised osteoarthritis most commonly affects the hands, feet, hip, knees and spine, and less commonly the shoulder and wrist joints. Pain is increased by movement and loading on the joint, and may radiate beyond the joint itself, as in leg pain associated with spinal disease, and knee pain radiating from the hip. 9

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12 Stiffness in the early morning lasts for less than 30 min, unlike rheumatoid arthritis; it may also occur after periods of rest and throughout the day. In the hands, the most commonly affected joints are the distal interphalangeal joint and the proximal interphalangeal joints. Unlike rheumatoid arthritis, there is no extraarticular disease. 12

13 Investigations Osteoarthritis is primarily diagnosed by its clinical presentation. Confirmation and progression can be achieved by radiography with the presence of joint space narrowing, bone sclerosis, cysts and deformity. On arthroscopy normal cartilage is smooth and white while osteoarthritic cartilage is yellowed, irregular and ulcerated. 13

14 Synovial fluid analysis should be carried out if one suspects infection or crystal arthropathy such as gout. Blood tests usually reveal a normal ESR and CRP. 14

15 Treatment The aims of treatment includes: pain relief Optimisation of function Minimisation of disease progression. 15

16 Non-pharmacologic therapy Management for all individuals with OA should begin with patient education, and physical therapy, and weight loss or assistive devices. Surgery can be recommended for OA patients with functional disability and / or sever pain that is unresponsive to conservative therapy. 16

17 Pharmacologic therapy Analgesics Acetaminophen Acetaminophen is the first line therapy for pain management in OA. It is causes hepatoxicity if high dose of acetminophen uses. It should be used with caution in patients with liver disease or those with chronically abuse alcohol. 17

18 Nonsteroidal anti-inflammatory drugs Non-selective NSAIDs or COX-2 inhibitors use for pain management in OA patients in whom paracetamol is ineffective. NSAIDs have analgesic properties at lower doses and antiinflammatory effects at high doses. analgisic effects of NSAIDs begin within hours, whereas anti-inflammatory benefits may require 2 to 3 weeks of continuous therapy. 18

19 The most common adverse events of NSAIDs are those that predominantly inhibit COX-1 and cause adverse gastrointestinal effects. These range from minor symptoms, including dyspepsia, nausea and diarrhoea, to more serious events, such as gastric erosion, bleeding and duodenal and gastric ulceration, So all patients taking a non-selective NSAID should receive concomitant treatment with a PPI to minimize gastro-intestinal adverse effects. NSAIDs may cause renal dysfunction, characterized by increased serum creatinine and blood urea nitrogen, hyperkalemia, elevated blood pressure, peripheral edema and weight gain. 19

20 COX-2 inhibition cause a prothrombotic state and promote cardiovascular disease. 20

Corticosteroids Intra-articular steroid injections(intra-articular methylprednisolone acetate injection and intraarticular triamcinolone)can provide excellent

21 Corticosteroids Intra-articular steroid injections(intra-articular methylprednisolone acetate injection and intraarticular triamcinolone)can provide excellent pain relief, particularly when a joint effusion is present. After injection, the patient should minimize activity and stress on the joint for several days. 21

22 Topical therapy Capsaisin can be used alone or in combination with oral analgesics or NSAIDs. Glucosamine and chondroitin Both agents had efficacy in reducing pain and improving mobility, and that Glucosamine reduced joint space narrowing. 22

23 Hyaluronate injections Hyaluronan is an endogenous molecule found in the synovial fluid. Its functions are to increase viscosity of synovial fluid and lubrication within the joint. Synthetic intra-articular injections of hyaluronan are thought to provide pain relief and improve joint function. 23

Osteoarthritis. RA Hughes

Osteoarthritis. RA Hughes Osteoarthritis RA Hughes Osteoarthritis (OA) OA is the most common form of arthritis and the most common joint disease Most of the people who have OA are older than age 45, and women are more commonly