OSTEOARTHRITIS

DEGENERATIVE JOINT DISEASE

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
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 Secondary OA

Etiology is unknown 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 sclerosis

Bone cysts
RADIOLOGIC GRADE OF OA

G1 Normal
G2 Mild
G3 Moderate
G4 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 Genu varum
OA OF KNEE JOINT

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
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
X-RAY OF HIP OA
Peripheral Joints

Hands
Feet
ETIOPATHOGENESIS OF OA

Age,gender
Local
Genetic OA biochemical
effects

Other factors
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