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Osteoarthritis
Osteoarthritis is a non-inflammatory,
degenerative condition of joints
Characterized by degeneration of
articular cartilage and formation of
new bone i.e. osteophytes.
Risk factors
Obesity
esp OA knee
Classification of OA
OA
Primary OA
Secondary OA
Primary OA
Secondary OA
Due to a predisposing cause such as:
1.Injury to the joint
2.Previous infection
3.RA
4.CDH
5.Deformity
6.Obesity
7.hyperthyriodism
Types of OA
Nodal Generalised OA
Crystal Associated OA
OA of Premature Onset
Nodal Generalised OA
Heberdens nodes
Bouchards nodes
CMC of thumb
Hallux
valgus/rigidus
Knees & hips
Apophyseal joints
Crystal Associated OA
Calcium pyrophosphate
dihydrate occurs
mainly in elderly
women, and principally
affects the knee
OA of Premature
Onset
Previous meniscectomy
Haemochromatosis
Pathology
OA is a degenerative condition
primarily affecting the articular
cartilage.
1.articular cartilage
2.Bone
3.Synovial membrane
4.capsule
5.Ligament
6.muscle
Articular Cartilage
Arthroscopic appearances
in OA of the knee joint:
fibrillated surface of the
cartilage on the medial
femoral condyle
Bone(Eburnation)
Synovial Membrane
Capsule
It undergoes fibrous degeneration and there
are low-grade chronic inflammatory changes
Ligament
Muscles
Undergoes atrophy,as pt. is not able to
use the jt. Because of pain which
further limits movts. and function.
Clinical features of OA
Pain
Stiffness
Muscle spasm
Restricted movement
Deformity
Muscle weakness or wasting
Joint enlargement and instability
Crepitus
Joint Effusion
Clinical
features
1
Clinical
features
Inflammatory phases
Movement abnormalities
Clinical
features
2
Clinical features 3
Deformities
Soft tissue swelling:
mild synovitis
small effusions
Osteophytes
Joint laxity
Asymmetrical joint destruction leading to
angulation
A patient with
typical OA of the
knees. In the normal
standing posture
there is a mild varus
angulation of the
knee joints due to
symmetrical OA of
the medial
tibiofemoral
compartments.
Pseudolaxity due
to cartilage loss.
The joint is not
loaded in the first
photograph
Unstable distal
interphalangeal
joints in OA. The
examiner is able to
push the joint from
side to side due to
gross instability, a
common finding in
late
interphalangeal
joint OA.
Radiographic
Stage 1
Bony spur only
Classification
Stage 2
Narrowing of jt.
Space,less than half of
the normal jt. space
Stage 3
Narrowing of jt.
Space,more than half
of the normal jt. space
Stage 4
Stage 5
Subluxation or
sec.lateral arthrosis
Distribution of OA of the
hip joint. OA can
maximally affect the
superior pole, inferior
pole, posterior part or
other segments of the
hip joint. Superior pole
involvement, with a
tendency for the head of
the femur to sublux
superolaterally, is the
commonest pattern.
Involvement of the whole
joint (concentric OA) is
relatively uncommon.
Special Investigations
Blood tests: Normal
Radiological features:
Cartilage loss
Subchondral sclerosis
Cysts
Osteophytes
Treatment Principles
Education
Physiotherapy
Exercise program
Pain relief modalities
Education
Nonsystemic nature of disease
Prevent overloading of joint. Obesity!!
Appropriate use of treatment modalities
Importance of exercise program
Aids, apliances, braces
Medial treatments
Surgical treatments
Exercise
Will not wear the joint out
Important for cartilage nutrition
Some evidence that lack of exercise leads to
progression of OA
Exercise
Encourage full range low impact movements
eg swimming, cycling
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. There is
a weight on the ankle.
Use of transcutaneous
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
Taping of patella in patello femoral OA
Medical Treatment
Simple analgesics: paracetamol, low dose
ibuprofen
NSAIDs/Coxibs PRN regular
Intra-articular corticosteroids
Topical treatment eg NSAID creams, capsaicin
Chondroprotective agents
A patient with OA of
the carpometacarpal
joint of the left thumb
undergoing
arthrocentesis for
injection of a depot
corticosteroid
preparation. The
operator is distracting
the patients thumb to
open up the joint
space.
Joint replacement
surgery
Indications: pain affecting work, sleep,
walking and leisure activities
Complications
sepsis
loosening
lifespan of materials (mechanical failure)
Osteoporosis: Challenges to
meet
Organic Component:
protein collagen &
specialized cells called
osteoclasts, osteoblasts,
and osteocytes
Inorganic component:
Mainly as calcium
phosphate, in the form of
Hydroxyapatite
Osteoporosis: Challenges to meet| BICC |
27th July, 2010
Bone Homeostasis:
the situation when the body
requires and achieves an
equal amount of bone
resorption and bone
formation
Homeostasis
5 Stages:
Initiation,
Resorption,
Reversal,
Bone formation and
Completion of remodeling.
Osteoporosis: Challenges to meet| BICC |
27th July, 2010
The lining cells rest on the bone surface until the next
cycle of bone remodeling begins.
Some osteoblasts become osteocytes.
Challenges of Osteoporosis
Osteoporosis: Challenges to meet| BICC |
27th July, 2010
National Osteoporosis
Foundation:
a disease characterized by low
bone mass an micro-architectural
deterioration of bone tissue,
leading to bone fragility and an
increased susceptibility to
fractures.
World Health Organization (1994)
:
bone mineral density T-score
greater than 2.5 standard
deviations from the mean peak
adult bone mass (ie. a woman in
her 30s).
Osteoporosis: Challenges to meet| BICC |
27th July, 2010
Being female
Older age
Family history of osteoporosis or broken bones
Being small and thin
History of broken bones
Low sex hormones
Low estrogen levels in women, including
menopause
Missing periods (amenorrhea)
Low levels of testosterone and estrogen in men
Diet
Low calcium intake
Low vitamin D intake
Excessive intake of protein,
and hip.
May measure other sites: total body and
forearm.
Validated in many clinical trials.
Available in Bangladesh.
Classification
T-score
Normal
-1 or greater
Osteopenia
Osteoporosis
-2.5 or less
Severe Osteoporosis
-2.5 or less
and fragility fracture
FRACTURE ,
The most serious complication of
Osteoporosis that leads to
Increased morbidity
Increased mortality
Decreased quality of life
Wrist fracture
men 1 in 40 (2.5%)
women 1 in 6 (16%)
Spinal fracture
men 1 in 20 (5%)
women 1 in 6 (16%)
Hip fracture
men 1 in 17 (6%)
women 1 in 6 (17.5%)
Therapeutic
Intervention
Minimizing risk
factors
Slowing/stopping
bone loss
Minimizing factors
that
Contribute to fall
Maintaining or
increasing bone
density and strength
Maintaining or
improving bone
microarchitecture
Supplements
such as which maintain bone mass Calcium,
Vitamin D
Anti-resorptive agents
which inhibit bone resorption
Bisphosphonates
Anabolic agents,
which stimulate bone formation and, in turn,
Ass Wr Wb