(OA) is the most common form of arthritis. It has a strong relation with ageing as its a major cause of pain and disability in older people
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Osteoarthritis is characterised by focal loss of articular cartilage, subchondral osteosclerosis, osteophyte formation at the joint margin, and remodelling of joint contour with enlargement of affected joints. ..
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Females are more commonly affected except that hips OA occurs equally in both sexes By age of 65, 80% of people have radiological OA 25-30% of them are symptomatic
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. The knee and hip are the principal large joints involved, affecting 10-25% of those aged over 65 years. Even in joints less frequently targeted by OA, such as the elbow, .glenohumeral joint
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Increasing age“excessive” joint loading & mobilityAbnormal mechanical forces (e.g. varus & valgus knee deformities)female sexGenetic predispositionObesity (for knees & hands O.A.)Muscle weaknessPrior joint disease *
Stages of cartilage lossSuperficial fissuring (fibrillation)Erosions & deep ulcersThinning & hypo-cellularityAreas of repair with fibrocartilage *
Bone Changes Subchondral sclerosis Osteophytes Subchondral cysts Remodeling (shape changes)
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Pain• Insidious onset over months or years• Variable or intermittent over time (‘good days, bad days’)• Mainly related to movement and weight-bearing, relievedby rest• Only brief (< 15 mins) morning stiffness and brief (< 5 mins)‘gelling’ after rest• Usually only one or a few joints painful *
• Restricted movement due to capsular thickening, or blockingby osteophyte• Palpable, sometimes audible, coarse crepitus due to rougharticular surfaces• Bony swelling around joint margins• Deformity, usually without instability• Joint-line or periarticular tenderness• Muscle weakness and wasting• Synovitis mild or absent *
Localized interphalangeal OA. (usually DIP) Generalized OA. Loading / mobility related OA.
*Osteoarthritis: Heberden’s nodes, inflammation *
Localized interphalangeal OA. (usually DIP)Heberden’s nods appears slowlyFemale & male 10/1Strong genetic factor *Osteoarthritis: Heberden’s and Bouchard’s nodes *
Generalized OA Usually post menopausal women Affect 3 or more joints or joints group Usually starts in the interphalangeal joints (DIPs & PIPs) Tendency to O.A. at other sites specially knee*
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Osteoarthritis: knees, medial (XR1) and lateral (XR2) cartilage degeneration
Medial loss is the usual in mobility / loading related O.A. kneeXR1
XR2
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Osteoarthritis: cervical vertebrae, foraminal encroachment
*Lumbar vertebrae, osteophytes (radiograph and photomicrograph)
*Osteoarthritis: lumbar vertebrae, advanced stages
*Spinal stenosis: lumbar spine (MRI) due to O.A.
*Non pharmacological ReduceobesityAvoid static loading e.g. prolonged squattingPacing of activityExercise specially non weight bearing (bicycle …) Joint rest techniques :Neck collar *
Oral analgesic : paracetamol Topical : capsacin & NSAIDs Systemic NSAIDs Intra-articular steroids with careful precautions Intra-articular hyaluronic acid products Glucosamine & chondroitins sulfate
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Osteotomy Total joint replacement (TJR) Cartilage repair surgery (cartilage auto-graft). Highly specialized centers Indications : uncontrolled pain & functional disability refractory to conservative therapy
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