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is a form of arthritis that features the

breakdown and eventual loss of the

cartilage of one or more joints.

The symptom of OA is Pain. Stiffness.

Muscle weakness. Swelling. Deformed
joints. Reduced range of motion and loss
of use of the joint. Cracking and creaking,
OA of the knee is a major cause of
History of acute injury,
Prolonged and excessive use of the
knee joint,
Previous fracture at that site of the
Genetic (hereditary) factors.
Patient interview. history taking, onset of his or her knee
symptoms, the pattern of pain and swelling and how symptoms
affect lifestyle
Physical exam.any signs of swelling, pain points, stiffness and
range of motion. The examination should extend above and
below the knee
Testing. Follow up tests may be included as part of the
diagnostic process both to gain further information about the
extent of the knee arthritis and/or to rule out other possible
causes of the patients pain.
X-rays. loss of joint space between the femur and tibia,
indicating a loss of cartilage in the knee.
MRI. Magnetic Resonance Imaging (MRI) may be ordered to
provide additional detail,
Lab tests. can be used to rule out other problems,
Grade 1: doubtful narrowing of joint space and possible
osteophytic lipping
Grade 2: definite osteophytes, definite narrowing of joint
Grade 3: moderate multiple osteophytes, definite
narrowing of joint space, some sclerosis and possible
deformity of bone contour
Grade 4: large osteophytes, marked narrowing of joint
space, severe sclerosis and definite deformity of bone
to alleviate both pain and functional
disability by a combination of
pharmacological and nonpharmacological
approaches (Cortisone shots, Lubrication
injections, Realigning bones, Joint
IA injections can involve hyaluronan or
Another local therapy for knee OA is
joint lavage
meta-analysis of randomized controlled
Searched MEDLINE, EMBASE and the
Cochrane Central Register of Controlled
Trials to obtain all reportspublished in
English of RCTs of joint lavage in knee
OA, published between 1966 and May
selected all reports of all parallel-group
RCTs of knee OA evaluating the efficacy
(i) joint lavage without steroid injection vs
control group or
(ii) joint lavage with steroid injection vs
joint lavage alone
The study population included patients
with OA as defined by the authors. In
all cases, the patients fulfilled ACR [9]
From the 49 articles identified, we
included 6 articles. Every articles have
77-205 patients.
We selected articles of RCTs with pain
and/or functional status outcomes. We
extracted data on efficacy (along with
their measurements of dispersal) as
measured by pain or functional
assessment at 3 months after joint
Outcome measured by pain and functional
disability, measured using Womac
The RCTs in our analysis involved 855
patients with OA (511 in the active
group and 344 in the control group), all
fulfilling the ACR criteria for knee OA
Reports of four RCTs provided the required
data on pain intensity for 212 participants
who received the active treatment and
228 who received placebo.
Pain: join lavage reduce paint compare
placebo, but not significant
physical function: joint lavage improve
physical function less than placebo, but
not significant
Reports of three RCTs provided the required data
on pain intensity for 299 participants who
received joint lavage plus corticoid injection and
for 116 patients who received joint lavage alone
Pain: join lavage alone reduce pain better than
join lavage kortiko, but not significant
physical function: cant be assest because the
data is not significant and no robust conclusion
Joint lavage is to remove debris such as
microscopic or macroscopic fragments of
cartilage matrix, bone macromolecules and
calcium crystals that may induce synovitis. A
likely source of pain.
On the basis of available evidence, arthroscopic
lavage seems to provide only short-term benefit
to selected patients with mild radiographic OA and
Arthroscopic debridement should not be used as
routine treatment for knee OA, although
patients with symptomatic meniscal tears and
loose bodies with locking symptoms could benefit.
hormones your body produces naturally in your
adrenal glands,
corticosteroids suppress inflammation, which
can reduce the signs and symptoms of
inflammatory conditions, such as arthritis and
Steroid injections generally result in a clinically
and statistically significant reduction in
osteoarthritic knee pain as soon as 1 week
after injection. The effect may last, on average,
anywhere from 4 to 6 weeks per injection, but
the benefit is unlikely to continue beyond that
time frame
Methylprednisolone decreases inflammation by
suppressing migration of polymorphonuclear
leukocytes (PMNs) and reversing increased
capillary permeability.
Betamethasone decreases inflammation by
suppressing migration of PMNs and reversing
increased capillary permeability. It affects the
production of lymphokines and has an inhibitory
effect on Langerhans cells.
Triamcinolone decreases inflammation by
suppressing migration of PMNs and reversing
capillary permeability.
Joint lavage and cortikosteroid can reduce
pain in OA, but not significan,
Join lavage have a short term effect that
possibly already relapse in post test
Corticosteroid also have specific time
frame for its effect. It might be the effect
was out of its frame, and the symptom
(pain and reduce physical function)
already relapse in post test measurement
(i) Joint lavage alone does not provide
significant improvement in pain or
function and
(ii) The combination of joint lavage and IA
steroid injection is no more efficacious
than lavage alone
Wassalamualaikum wr wb
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is a widely used,
proprietary set of standardized questionnaires used by health professionals to evaluate the
condition of patients with osteoarthritis of the knee and hip, including pain, stiffness, and physical
functioning of the joints. The WOMAC has also been used to assess back pain, rheumatoid arthritis,
juvenile rheumatoid arthritis, systemic lupus erythematosus , and fibromyalgia. It can be self-
administered and was developed at Western Ontario and McMaster Universities in 1982. [1]
The WOMAC measures five items for pain (score range 020), two for stiffness (score range 08),
and 17 for functional limitation (score range 068). [2]. Physical functioning questions cover
everyday activities such as stair use, standing up from a sitting or lying position, standing,
bending, walking, getting in and out of a car, shopping, putting on or taking off socks, lying in bed,
getting in or out of a bath, sitting, and heavy and light household duties. [3]
A WOMAC test takes about 12 minutes, but is also available in a short form, (although this has not
been as extensively tested as the full version). Versions of the WOMAC have also been developed
that can be used in telephone or online surveys. [3]
The WOMAC is among the most widely used assessments in arthritis research. For example, it
appears as a search keyword in more than 1500 papers cataloged in PubMed, as of June, 2012. It
has been translated into more than 65 languages. [1].
The American College of Rheumatology notes that the test-retest reliability of the WOMAC varies
for the pain, stiffness, and function subscales. The ACR says the pain subscale "has been variable
across studies but generally meets the minimum standard." Reliability for the physical function
scale "has been more consistent and stronger... but the stiffness subscale has shown low test-
retest reliability."[3] When used in clinical studies, the WOMAC pain and function subscales perform
comparably or better than other tests in being responsive to change from experimental
interventions, but this varies for the different subscales and types of intervention.
An example of an arthritis study using the WOMAC [4] found a significant dose-response relationship
between 10% body weight loss (or gain) and clinically significant improvements (or declines) in
WOMAC function and pain for people with osteoarthritis of the knee.
A Method for assessing the quality of controlled clinical trials
Basic Jadad Score is assessed based on the answer to the following 5
The maximum score is 5.

Question Yes No
1. Was the study described as random? 1 0
2. Was the randomization scheme described and appropriate? 1 0
3. Was the study described as double-blind? 1 0
4. Was the method of double blinding appropriate? (Were both the patient
and the assessor appropriately blinded?) 1 0
5. Was there a description of dropouts and withdrawals? 1 0

Quality Assessment Based on Jadad Score

Range of Score Quality

02 Low
35 High