BY JOBIN

OSTEOARTHRITIS
Osteoarthritis (Degenerative joint disease) is the most

common form of arthritis in older adults. Arthritis (from Greek arthro-joint & itis- inflammation) is a group of conditions involving damage to the joints of the body.

synovial& fibrous joint

 Ligaments: are bands of fibrous tissue that connects

bones at joints and provide stability during movement. Cartilage: is a protein substance that serves as a "cushion" between the bones of the joints.

DEFINITION

Osteoarthritis also known as Osteoarthrosis, is

a slowly progressive disorder of the joints characterized by gradual loss of cartilage resulting in the development of bony spurs at the margins of the joints. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint Osteoarthritis commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees.

INCIDENCE
Upto the age of 55 osteoarthritis occurs equally in both sexes.
After the age of 55 the incidence is higher in

women. It is estimated that approximately four out of 100 people are affected.

CLASSIFICATION BASED ON CAUSE

Primary

secondary

RISK FACTORS
Increased age
Genetic factors Trauma

Mechanical stress
Inflammation of joint structures Joint instability Neurologic disorders Endocrine disorders

Medications
Hormonal factors

PATHOPHYSIOLOGY
Cartilage lining the joints provides smooth surface avoiding friction of bone. collagen and proteoglycans are lost from cartilage Cartilage becomes yellow or brown gray and loses its tensile strength Large area of cartilage is lost and underlying bone is exposed

Bone rubs against each other causing pain

Spurs develop leading to synovitis

CLINICAL MANIFESTATIONS
joint pain
Stiffness crepitation

Joint swelling
Limited movement Muscle weakness around arthritic joints

paresthesias
joint effusion Heberden's nodes: knobby bony deformity at the

smallest joint of the end of the fingers Bouchard's nodes: bony knob (node) occurs at the middle joint of the fingers

DIAGNOSTIC FINDINGS
A physical examination can show:

Joint movement may cause a cracking (grating) sound Joint swelling (bones around the joints may feel larger than normal) Limited range of motion Tenderness when the joint is pressed Normal movement is often painful.

An x-ray of affected joints will show a loss of the joint space

The common findings include loss of joint cartilage, narrowing of

the joint space between adjacent bones, and bone spur formation.

Goals of management are To relieve the pain To maintain as much normal joint function as possible.

MEDICATIONS
Analgesics

acetaminophen (Tylenol) 1000mg every every 6 hours. NSAIDs Ibuprofen(Mortin)200mg up to 4times/day Naproxen (Anaprox) Topical medications capsaicin cream(zostrix) Corticosteroids : injected right into the joint can also be used to reduce swelling and pain. Methylprednisolone acetate(Depo-medrol)

 ROM exercise, muscle strengthening exercise

Heat and cold therapy Balance between exercise and rest

Use of cane ,crutches and walkers

Weight loss if indicated Nutritional therapy Alternative therapy

Yoga,Massage,Acupunture

SURGICAL MANAGEMENT
Arthroplasty total or partial replacement of the

deteriorated joints with an artificial joints. This is usually done in knee and hip region Arthrodesis surgical fusion of bones.Articular joint surfaces are removed so that bone edges unite together. Osteotomy :incision into bones performed to realign the affected joint

MANAGEMENT
Non-pharmacologic treatment (patient education, exercise)

Non-opiod analgesics (acetaminophen, up to 4 g/day), topical capsaicin cream applied to joint 4 times a day
If symptoms persist, add non-steroidal anti-inflammatory drugs (i.e. ibuprofen 600-800 mg tid) Administer intra-articular corticosteroid injections maximum per 12 months, injection, 3-4

Refer to orthopaedic surgeon