Osteoarthritis
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Osteoarthritis is a non-inflammatory degenerative condition of the joints characterized by degeneration of articular cartilage and formation of new bone (osteophytes). It commonly affects the hands, knees, hips and spine. Risk factors include age, gender, obesity, injury and genetics. Symptoms include pain, stiffness, swelling and loss of flexibility. Diagnosis is made based on symptoms and confirmed with x-rays or MRI. Treatment involves medications like acetaminophen, NSAIDs, opioids and diacerein as well as complementary therapies and surgery for advanced cases.
Osteoarthritis
- 2. What is Arthritis? Acute or chronic inflammation of a joint, often accompanied by pain and structural changes and having diverse causes, as infection, crystal deposition, or injury
- 3. Osteoarthritis Osteoarthritis is non inflammatory degenerative condition of joints characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.
- 5. •Affect DIP, PIP, 1st Carpometacarpal, knee, hip, spine Primary OA (Idiopathic) •Affect less common joint as wrist, metacarpophalangeal, shoulder. Secondary OA Types of Osteoarthritis
- 6. Risk Factors PRIMARY Age Gender Obesity High Bone Mass Mechanical : Repetitive bone use squatting SECONDARY Injury to joint : Traumatic or inflammatory Heamoartharosis Congenital/Developmental Neuropathic joint Metabolic (Paget's Disease)
- 7. Macro structural & Pathological Changes Macro structural Loss of articular cartilage Subchondral cyst Osteophytes Sclerosis Muscle wasting Pathological Cartilage Fibrilation Subchondral new bone Myxoid degeneration Trabecular compression
- 8. Sign & Symptoms • Pain • Tenderness • Stiffness • Loss of flexibility • Grating sensation • Crepitus • Bone spurs
- 9. Knee OA The classical criteria for OA of knee is based upon the presence of knee pain plus at least 3 of the following 6 clinical characteristics 1. Age >> 50 years 2. Morning stiffness for < 30 minutes 3. Crepitus on active motion of knee 4. Bony tenderness 5. Bony enlargement 6. No palpable warmth
- 10. Hand OA The classical criteria for OA of hand is based upon the presence of hand aching or stiffness plus at least 3 of the following 4 features 1. Hard tissue enlargment of 2 or more of 10 selected joint. The 10 selected joints are the second and third distal interphalangeal (DIP) joints, second and third proximal interphalageal (PIP) joints and the first carpometacarpal (CMC) of both hands. 2. Hard enlargement of two or more DIP joints. 3. Fewer than 3 swollen metacarpophalangeal (MCP) joints. 4. Deformity of atleast 1 of the 10 selected joints.
- 11. Hip OA The presence of hip pain plus at least two of the following 3 features 1. ESR of less than 20mm/h 2. Radiographic osteophytes (femoral or acetabular) 3. Joint space narrowing on radiography (superior, axial or medial)
- 12. Spine OA Most common at C5, T8 and L3 1. OA of spine is a breakdown of the cartilage of the joints and discs in the neck and lower back. 2. OA produces spurs that put pressure on the nerves leaving the spinal column.
- 13. Diagnosis • Pain Radiography • MRI • Bone Scanning • Synovial Fluid Analysis
- 14. Therapeutic Approach to Osteoarthritis
- 15. Therapeutic Approach to Osteoarthritis Acetaminophen Dose 650 to 1000 mg up to 4 times per day NSAID Therapy Short acting NSAIDs (ibuprofen ) Long acting NSAIDs (diclofenac , naproxen , nabumetone) – greater relief COX2 inhibitors (celecoxib) Opioids Only when acetaminiphen or NSAIDs fail Starts with low dose Tramadol and Duloxetine Diacerein Blocks interleukin-1 Disease modifier for OA. Daicerein increase proteoglycans and hyaluronan
- 16. NSAID - MOA
- 17. Opioids - MOA
- 18. Diacerein - MOA 1. Matrix metalloproteinases
- 19. Complementary and Alternative Medicines • Intra articular injection for corticosteroids or hyaluronic acid • Acupuncture • Heat and Cold • Glucosamine/Chondroitin • Synovial Fluid Supplements • Capsaicin Cream • Diclofenac Gel
- 20. Surgical • Arthroscopy • Osteotomy • Arthroplasty