OSTEOARTHRITIS

Presented by :
Athaya Hafizhah
Ria Subarti

Pembimbing :
dr. Aswedi Putra Sp.OT. FICS

KEPANITERAAN KLINIK SENIOR DEPARTEMEN ILMU BEDAH

RUMAH SAKIT PERTAMINA BINTANG AMIN
FAKULTAS KEDOKTERAN UNIVERSITAS MALAHAYATI
BANDAR LAMPUNG
 WHAT IS OSTEOARTHRITIS ???

Femur
Osteoarthritis is a
degenerative disease of
synovial joints
characterized by focal loss
of articular hyaline
cartilage with proliferation
of new bone & remodeling of
joint contour.
 EPIDEMIOLOGY
• Weight bearing joints e.g. knee & hip joints.

• Age > 65 years.

– 80% have radiographic features.
– 25-30% have symptoms.

• More common in women.

• Familial tendency.
DISTRIBUTION
STRIBUTIONOFOFDISEASE
DISE
 ETIOLOGY

• PRIMARY/IDIOPATHIC:
When there is no obvious predisposing
factor. Common form of OA.

• SECONDARY:
When degenerative joint changes occur in
response to a recognizable local or systemic
factor.
CAUSES OF SECONDARY OSTEOARTHRITIS
 RISK FACTORS

CONSTITUTIONAL MECHANICAL FACTORS

SUSCEPTIBILITY

AGEING
 PATHOGENESIS

Progressive destruction &

loss of articular cartilage
with an accompanying
peri-articular bone
response leads to
l ' ' exposure of sub-chondral
bone which becomes
sclerotic, with increased
blood vascularity & cyst
formation.
 CLINICAL FEATURES
• Pain:
– Activity & weight-bearing
related, relieved by rest.
– Variable over time.
– Only one or few joints involve d.

• Morning stiffness only brief

<30 minutes.

• Restricted functionality:
– Capsular thickening.
– Blocking by osteophytes.
 CLINICAL FINDINGS IN NODAL
GENERALIZED OA
• Presentation typically in women. (40 & 50 years)

• Pain.

• Stiffness.

• Swelling of one or few finger interphalangeal

joints ( distal > proximal). .....__~_ Bouchard'.
node

• Heberden’s nodes (+/- Bouchard’s nodes).

• Involvement of first carpometacarpal joint is

common.

• Predisposition to OA at other joints specially

knees.
 CLINICAL FINDINGS IN KNEE OA
• Targets patello-femoral & medial tibio-femoral compartments of knee.

• Pain is localized to anterior or medial aspect of knee & upper tibia.

• Jerky gait.

• Varus deformity.

• Joint line &/or periarticular tenderness.

• Weakness & wasting of quadriceps muscle.

• Restricted extension & flexion.

• Bony swelling around joint.

 CLINICAL FINDINGS IN HIP OA
• Targets mostly superior aspect & less commonly medial aspect of joint.

• Pain is maximally deep in groin area.

• Antalgic gait.

• Weakness & wasting of muscles (quadriceps & gluteal).

• Pain & restricted internal rotation with flexion.

 CLINICAL FINDINGS IN EARLY-
ONSET OA
• Before the age of 45 years.

• Single or multiple joint involvement.

• Typical signs & symptoms of OA.

/
CLINICAL FEATURES IN EROSIVE OA
• Preferentially targeting proximal IPJs.

• Common development of IPJ lateral instability.

• Sub-chondral erosions on x-rays.

• Ankylosis of IPJs.
MARGINAL OSTEOPHYTES
 INVESTIGATIONS
• BLOOD TEST:
– FBC NORMAL.
– ESR NORMAL.
– CRP NORMAL.
– RHEUMATOID FACTOR NEGATIVE.

• SYNOVIAL FLUID ANALYSIS:

– VISCOUS WITH LOW TURBIDITY.
– CPPD & CALCIUM PHOSPHATE.
 MANAGEMENT
NON•
PHARMACOTHERAPY
 NON-PHARMACOTHERAPY
– Full explanation of the condition via patient education:

• Properly position and support your neck and back while sitting or sleeping.

• Adjust furniture, such as raising a chair or toilet seat.

• Avoid repeated motions of the joint, especially frequent bending.

• Lose weight if you are overweight or obese,

which can reduce pain and slow progression
of OA.

• Exercise each day.

• Build confidence.
 NON-PHARMACOTHERAPY
• Exercises:
• Aerobic conditioning.

• Muscle strengthening exercises.

• Reduction of adverse mechanical

factors:
• Weight loss.

• Pacing of activities.

• Appropriate footwear.
 PHARMACOTHERAPY
PARACETAMOL WEAKOPIOIDS
•Initial drug of choice •Occasionally required.
•Orally 1 gm 6-8 hourly •e.g: dihydrocodeine

NSAIDs INTRA-ARTICULAR
•Indicated as needed. CORTICOSTEROIDS
•Oral e.g: ibuprofen & coxibs INJECTIONS
•Topically e.g: capsaicin •3-5 weekly.
0.025% cream

HYALURONIC INJECTIONS
•Injections for 3-5 weeks.
•Pain relief for several months.
.
THANK YOU
 DIFFERENTIAL DIAGNOSIS
FEATURES OSTEOARTHRITIS RHUEMATOID GOUT
ARTHRITIS
PRESENCE OF SYMPTOMS Systemic symptoms are Frequent fatigue and a Chills and a mild fever
AFFECTING THE WHOLE not present. general feeling of being ill along with a general
BODY: are present feeling of malaise may
also accompany the
severe pain and
inflammation
DURATION OF MORNING Morning stiffness lasts Morning stiffness lasts Not seen
STIFFNES S: less than 30-60 mins; longer than 1 hour.

NODULES: Heberden's & bouchard's Heberden’s nodes are

nodes absent.

PAIN WITH MOVEMENT: Movement increases pain Movement decreases pain

AGE OF ONSET: Most commonly occurs in Usual age of onset is 20- Usually over 35 yrs of age
individuals over the age 40 years. in men and after
of 50. menopause in females

LAB FINDINGS: Ra factor & anti-ccp Ra factor & anti-ccp Joint fluid microscopy is
antibody negative. antibody positive. Esr & c- diagnostic.
Normal esr & c-reactive reactive protein elevated.
protein.