Osteoarthritis and

Rheumatoid Arthritis

Farry, dr

IN TRO D U CTIO N
Osteoarthritis and inflammantory arthritis both cause

significant disability synovial joint destruction

The destruction occurs via different mechanism

O steoarthritis Vs.Rheum atoid Arthritis

Chronic
Articular

Chronic
Systemic

Degenerative

Autoimmune disorder
Symmetric

disorder
Ussually
asymmetric
Weightbearing
joints and ends of
fingers

polyarthritis
Hands, feets, wrists,
elbows, shoulders,
neck
Extraarticular
manifestation

Characteristics of rheumatoid arthritis and

osteoarthritis
Characteristic
Age at which
the condition
starts
Speed of onset

Rheumatoid arthritis
It may begin any time in
life.

Relatively rapid, over

weeks to months
Joint symptoms Joints are painful, swollen,
and stiff.
Pattern of joints It often affects small and
that are
large joints on both sides of
affected
the body (symmetrical),
such as both hands, both
wrists or elbows, or the
balls of bothfeet.

Duration of
morning
stiffness

Morning stiffness lasts

longer than 1 hour.

Osteoarthritis
It usually begins later in life.

Slow, over years

Joints ache and may be tender
but have little or no swelling.
Symptoms often begin on one
side of the body and may
spread to the other side.
Symptoms begin gradually
and are often limited to one
set of joints, usually the finger
joints closest to the fingernails
or the thumbs, largeweightbearing joints (hips, knees), or
the spine.

Morning stiffness lasts less

than 1 hour; returns at the end
of the day or after periods of
activity.
of
Frequentfatigueand a
Whole-body symptoms are not
Taken from:Presence
http://www.webmd.com/rheumatoid-arthritis/tc/comparing-rheumatoid-arthritis-andsymptoms
general feeling of being ill present.
osteoarthritis-topic-overview

O STEO ARTH RITIS

1990

27 million American with

OA

Will increase to more than

47 million
2020 Sosioeconomic impact

IN CID EN CE
In a study of self-reported OA in any

joint, (men and women)

10-15% 34 44 y.o.
50% 65 74 y.o.
Radiographic evidence ( > 60 y.o. ) :
33% in the hand & 33% in the knee
40 50% have no symptoms

D EFIN ITIO N
a degenerative disease of the synovial
joint that involves the progressive focal
loss of the articular cartilage and includes
extensive bone changes as prominent
features,
the disease involves
all the joint
structures

STRU CTU RAL O A

Focal loss of articular cartilage
The presence of osteophytes and

other bone changes

Radiographic is used to asses most
patient with structural
For research of structural OA,
arthroscopy is the gold standard.
MRI methods can provide additional
detail of the cartilage structure

SYM PTO M ATIC O A

Clinical diagnosis requires not only

changes in the synovial joint, but

also the presence of symptoms that
possibly incluse :
1. Joint pain
2. Decreased joint motion
3. Joint effusion
4. Crepitus with motion
5. Joint deformity

Factors Contributing to Secondary

Arthritis
System
ic

Growth
Factor
Dysregulatio
n

Local

Disruption of
joint
continuity

Abnormal
loading

Abnormal
loading

Metabolic
defect

Cartilage
damage
Bone
changes

 Obesity
Injurious
activities

INTRINSIC

Age
Ethnicity
Gender
Hormona
l status
Bone
density
Nutrition
al factors
Genetics

EKSTRINSIC

SYSTEMIC

EPID EM IO LO GY AN D CLIN ICALLY ID EN TIFIED

RISK FACTO RS

Malalignme
nt
Propriocepti
on
Laxity
Previous
trauma
Bridging
muscle
weakness

ETIO LO GY

Age

Older > younger

Age-related changes of
cartilage are not part of the
pathology of OA

Genetics

Mutation in type II collagen,

type IX collagen, and
cartilage oligomeric prote

Mediator
s

Proinflammatory cytokines
(IL-1 and TNF-)
Oncostatin M, IL-8, COX-2

PATH O LO GY
Progressive cartilage destruction
Subarticular cyst formation
Sclerosis of the surrounding bone
Osteophyte formation
Capsular fibrosis

CardinalSigns O fO A
Joint space narrowing
Subchondral sclerosis
Subchondral cyst
Osteophyte formation

Kellgren & Law rence

Classifi
cation

PRIN CIPLES O F M ED ICAL TH ERAPY

Hyaluronic acid
Glucosamine
Chondroitin sulfate
COX inhibitors

H yaluronic acid

Increase
viscosity
of
synovial
fluid

Decrease
pain

Improve
gait

G lucosam ine
Unknown mechanism
Relieves pain approx 50-60% in early OA

Precursor for
the synthesis
of chondroitin
sulfate

chondroprotect
ive

Oral glucosamine reach the joint in low

concetration

Chondroitin sulfate

Combination with glucosamine

Reach the joint in small concetration

COX inhibitors

COX-2 detected in damaged joints in

OA

Surgery
Indication :
Intolerable symptoms
Loss of function
Restriction of daily activities

Choices :
Osteotomy
Joint replacement
Arthrodesis

RH EU M ATO ID ARTH RITIS

Progressive inflammaory disease of the

synovial joint
Characterized by leukocyte infiltration
of the synovial tissue, synovial
hyperplasia, erosion of articular
cartilage and localized bone
resorptionpain and loss of function
Affect >1% of the general population
and has a significant socioeconomic
impact

CLIN ICAL AN D M O RPH O LO G IC

FEATU RES

Women : men =

3:1
20 60 y.o., peak
onset : 4th and 5th
decades
Clinically :
Pain and
swelling
Often
symmetrically

Radiographic :
Joint space
narrowing
Malalignment of
the bones
Focal bone
erosion
Bone cyst in the
ephyseal regions

Joint
distribution

PATH O G EN ESIS
Adaptive Immune System : T and B

Lymphocytes and Antigen-Presenting

Cells
Innate Immune System :
Granulocytes, Macrophages, and
Accessory Cells
The Cytokines Network
Chemokines and Adhesion Molecules

M ECH AN ISM S O F JO IN T
D ESTRU CTIO N
Cartilage

Destruction
Invasion of articular

cartilage by
synovial pannus

Bone Erosion

promote osteoclast
recruitment and
activation

CLIN ICAL AN D M O RPH O LO G IC

FEATU RES
Histopathology :
leukocyte infiltration in the synovial
tissue
prominent accumulation of mononuclear
cells around blood vessels
hyperplasia of the
synovial lining and
neovascularization

PRIN CIPLES O F D RUG -BASED M ED ICAL

TREATM EN T
Principle :control inflamation as

rapidly as possible
Nonsteroidal Anti-Inflammatory
Drugs and Corticosteroids
Disease-Modifying Antirheumatic
Drugs (DMARDs) methotrexate

Surgery
Indication :
Fixed deformity
Loss of function
Restriction of daily activities

Choices :
Osteotomy
Joint replacement
Arthrodesis

SU M M ARY
Both OA and RA cause significant

disability because of joint destruction

but by very different mechanism

TH A N K YO U