Transcript Osteoarthritis OA

OSTEOARTHRITIS
OSTEOARTHROSIS
DEGENERATIVE JOINT DISEASE
Prof. Dr. Ülkü Akarırmak
DEFINITION
Osteoarthritis OA is a degenerative
disease of diarthrodial (synovial)
joints, characterized by
Breakdown of articular cartilage
and proliferative changes of
surrounding bones
EPIDEMIOLOGY
Osteoarthritis(OA) is the most common
joint disease
OA of the knee joint is found in 70% of
the population over 60 years of age
Radiological evidence of OA can be
found in over 90 % of the population
LIMITED FUNCTION
OA may cause functional loss
Activites of daily living
Most important cause of disability in
old age
Major indication for joint replacement
surgery
CHARACTERISTICS OF OA
OA is a chronic disease of the
musculoskeletal system, without
systemic involvement
OA is mainly a noninflammatory
disease of synovial joints
No joint ankylosis is observed in the
course of the disease
CLASSIFICATION OF OA
Primary OA
Etiology is unknown
Secondary OA
Etiology is known
AGE
Primary OA > 40 years
Direct correlation
Aging process
RISK FACTORS FOR PRIMARY
OA
Age
Sex
Obesity
Genetics
Trauma (daily)
SECONDARY OSTOARTHRITIS
Trauma
Previous joint disorders;
Congenital hip dislocation
Infection: Septic arthritis, Brucella, Tb
Inflammatory: RA, AS
Metabolic: Gout
Hematologic: Hemophilia
Endocrine: DM
ETIOLOGY OF OA
Cartilage properties
Biomechanical problem
Morphology of Primary OA
Primary Generalized OA
STRUCTURE OF JOINT
CARTILAGE
Collagen (Type 2)
Proteoglycan
- Hyaluronic acid
- Glycoseaminoglycan
Water
Condrocyte
Regeneration and Degeneration
PATHOLOGY OF OA
Fibrillation
Eburnation
Osteophytes
Subcondral cysts
LABORATORY FINDINGS OF
OA
There are no pathognomonic laboratory
findings for OA
Laboratory analysis is performed for
differential diagnosis
RADIOLOGIC FINDINGS OF OA
Narrowing of joint space
(due to loss of cartilage)
Osteophytes
Subchondral (paraarticular) sclerosis
Bone cysts
RADIOLOGIC GRADE OF OA
G1
G2
G3
G4
Normal
Mild
Moderate
Severe
Kellgren Lawrence Classification
DIAGNOSIS OF OA
CLINICAL FINDINGS
Joint pain
+
RADIOLOGIC FINDINGS
Osteophytes
CLINIC OF OA
SIGNS AND SYMPTOMS
Joint pain - degenerative
Stiffness following inactivity – 30 min
Limitation of ROM – later stages
Deformity – restricition of ADL
OA OF KNEE JOINT (GONARTHROSIS)
More common in obese females
over 50 years of age
Joint stiffness (<30 minutes)
Mechanical pain
Physical examination findings: Crepitus
Pain on pressure
Painful ROM and functional limitation
Limitation of ROM in later stages of OA (first
extension)
Laboratory analysis within normal limits
GENU VALGUM - ORTHOSIS
RADIOLOGIC FINDINGS?
GRADE 1 - 4?
OA OF HIP JOINT
More common in males over 40 years
of age
Joint stiffness
Pain of hip, gluteal and groin areas
radiating to the knee (N obturatorius)
Mechanical pain
Limited walking function
COXARTHROSIS
Physical examination:
Antalgic limping
Limitation of ROM (first internal rotation)
Painful ROM
Trendelenburg test positivity
Leg length discrepancy
Laboratory analysis within normal limits
BIOMECHANICS
X-RAY OF HIP OA
Peripheral Joints
Hands
Feet
ETIOPATHOGENESIS OF OA
Age,gender
Local
Genetic
biochemical
Other factors
OA
effects
ETIOPATHOGENESIS OF OA
Dysfunction of joint cartilage
Condrocyte function: 1- Degredative enzymes
(metalloproteases)
2- Inhibitors
Degeneration and regeneration functions are
balanced
IL-1  , degredative enzymes + synovial
inflammation results: Breakdown of cartilage
PATHOGENESIS OF OA
Cytokines
IL-1, IL-6, TNF-
Cell destruction
Membrane phospholipids
Arachidonic acid
Cox-1, Cox-2
IL-1 and metalloproteases have been
found to play an important role in
cartilage destruction.
Local growth factors, especially
transforming growth factor (TGF) are
involved in the formation of
osteophytes
TREATMENT OF OA
Symptomatic treatment
Structure modifying treatment
Surgical treatment
STRUCTURE MODIFYING
TREATMENT
Hyaluronic acid injection (HA)
Glycose amino glycans (GAG)
PRIMARY PREVENTION OF OA
??
Regular exercises
Weight control
Prevention of trauma
AIMS OF OA TREATMENT
Pain relief
Preservation and restoration of joint
function
Education
Non-Pharmacologic
Treatment of OA
Patient education
Weight loss (if overweight)
Aerobic exercise programs
Physical therapy
Range-of-motion exercises
Muscle-strengthening exercises
Assistive devices for ambulation
Patellar taping
Appropriate footwear
Lateral-wedged insoles (for genu varum)
Bracing
Occupational therapy
Joint protection and energy conservation
PHARMACOLOGIC TREATMENT OF OA
Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
Topical agents
HAND OA - RESTING SPLINT
SYMPTOMATIC TREATMENT OF OA
Decrease of joint loading
- Weight control
- Splinting
- Walking sticks
Exercises
- Swimming
- Walking
- Strengthening
Patient education
INDICATIONS OF SURGICAL
INTERVENTION
Severe joint pain,
resistant to conservative treatment
methods
Limitation of daily living activities
Deformity, angular deviations,
instability
INVASIVE METHODS
Joint lavage
Arthroscopy
Cartilage grefting- genetic engineering
Surgery
Osteotomy
Joint replacement
QUESTIONS?