osteoarthritis.pptx

Primary Osteoarthritis and its
Orthopaedics Implication
Presenter: Bishwa Bandhu Niraula

Learning Objectives:
• Primary OA and its Pathogenesis
• Stages of OA
• Implications of OA in Orthopaedics
• Diagnosis and Management
• Brief detail on Knee, Hip, Spine, Hand, Ankle, Shoulder OA
• Recent advances

Osteoarthritis
• k/a OA, degenerative joint disease
• Specific cause unknown, mechanical and molecular involvement
• Onset gradual, after 40y, may start before
• Classified broadly as primary and secondary
• Primary OA also k/a idiopathic OA
• Primary OA not a/w any underlying cause

Primary Osteoarthritis and its Pathogenesis
• Degenerative, non-inflammatory, destruction of articular cartilage
• Primary OA has no predisposing factors
• Most common form of arthritis affecting adults and elderly
• Radiographic evidence by 65yrs, 80% over 75yrs.
• MC symptoms : Mechanical pain
• MC joint : Knee, Pathognomic : 1st CMC
Source: Aboulenain S, Saber AY. Primary Osteoarthritis. StatPearls [Internet]. 2020 Dec 2.

Pathophysiology
• 3 major process:
1) Mechanical wear and tear
2) Structural degeneration
3) Joint Inflammation

Source: He Y, Li Z, Alexander PG, Ocasio-Nieves BD, Yocum L, Lin H, Tuan RS. Pathogenesis of osteoarthritis: risk factors,
regulatory pathways in chondrocytes, and experimental models. Biology. 2020 Aug;9(8):194.

Source: Yunus MH, Nordin A, Kamal H. Pathophysiological Perspective of Osteoarthritis. Medicina. 2020 Nov;56(11):614.

Progression of osteoarthritis
• Stage 1 : Proteolytic breakdown of cartilage matrix
• Stage 2 : Fibrillation, Erosion of cartilage surface,
release of proteoglycan and collagen into synovium
• Stage 3 : Breakdown products induce chronic inflammation,
contribute to further cartilage breakdown

Risk factor
• A) Person Level factor : B) Joint Level factor:
-Age - Injury
-Gender - Malalignment
-Weight - Abnormal mobility of the joint
-Genetics - Usage
-Race/Ethnicity
-Diet
• Source: Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Risk factors and burden of osteoarthritis. Annals of physical and rehabilitation medicine. 2016 Jun 1;59(3):134-8.

Risk Factors
• Age - Strongest risk factors, sensescense related changes
• Gender - F>M, joint alignment, ligament strength,
pregnancy, bone density, Menopause,
role of estrogen in OA development and pain sensitization
• Anatomical factors, joint malalignment, congenital deformities
• Modifiable environmental factors - occupations
- obesity, metabolic syndrome, smoking,
- vitamin D deficiency, muscle weakness,low bone
density

Genetics
• evidence from epidemiological studies
• Studies - family history and family clustering, twin studies, exploration of rare genetic
disorders
• 39% & 65% in radiographic OA of hand & knee in women,
60% in OA hip, 70% in spine
• Chromosomes 2q, 9q, 11q,16p
• Genes : AGC1, IGF-1, ER alpha, TGF beta,
CRTM (cartilage matrix protein), CRTL (cartilage link protein),
collagen II, IX, and XI
Source: Spector TD, MacGregor AJ. Risk factors for osteoarthritis: genetics. Osteoarthritis and cartilage. 2004 Jan 1;12:39-44.

Epidemology:
• A/t Global Burden of Disease, Injuries and Risk factors study 2017(GBD 2017)
Global Incidence of OA- 263 million,
Incidence- 13 million/year
• Gender : Women> Men due to difference in
joint alignment & ligament strength,
pregnancy and
bone density
• Post Menopausal women at higher incidence, role of Estrogen.
• Weight bearing joints as knee and hip.
(Source: Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best practice & research Clinical rheumatology. 2014 Feb 1;28(1):5-15.

Effect of estrogen on target articular tissue
Source: Roman-Blas JA, Castañeda S, Largo R, Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arthritis research & therapy. 2009 Oct;11(5):1-4.
Estrogen actions on target articular tissues. ACL, anterior cruciate ligament; [Ca2+]i, intracellular calcium concentration; COX-2,
cyclooxygenase-2; IGF, insulin-like growth factor; iNOS, inducible nitric oxide synthase; MRI, magnetic resonance imaging; OB, osteoblast;
OVX, ovariectomized; PG, proteoglycan.

Protective mechanism of synovial joint
• Articular Capsule
-2 layers (1) outer fibrous capsule
(2) inner synovial membrane
• Synovial membrane and Synoviocytes
• Synovial fluids
• Nerve and Blood supply
• Bursa and Synovial Sheath
• Ligaments and Tendon insertion

Protective mechanisms in synovial tissue
• Predominantly fibrofatty areolar tissue
• CD68+ macrophages, CD55+ fibroblast-like synoviocytes
• ILR1Ra present, TNFα & IL1ß rarely detected
• cell adhesion molecules rarely detected except ICAM-1, VCAM-1
• OPG abundant on synovial lining macrophages, endothelial cells
• OPG expression over RANKL and IL1Ra over IL1 important for protection
Source: Smith MD, Barg E, Weedon H, Papengelis V, Smeets T, Tak PP, Kraan M, Coleman M, Ahern MJ. Microarchitecture and protective mechanisms in synovial tissue
from clinically and arthroscopically normal knee joints. Annals of the rheumatic diseases. 2003 Apr 1;62(4):303-7.

Anatomy of joint in relation to OA
• Cartilage, synovium, subchondral bone all involved
• Cartilage:chondrocytes, type 2 collagen + aggrecan
chondrocytes release cytokines,matrix degrading enzyme
• Subchondral bone: between calcified cartilage and trabecular bone
osteophytes, subchondral cyst formation
• Synovium: Synovitis common feature of OA
Proliferation of synoviocytes, synovial tissue hypertrophy
reduced lubricating function

History of Illness
• Progression slow over years or decades
• Less activity, patient may become obese
• Early disease joint may appear normal
• Pain, also reduced ROM and Crepitus
• Initially managed with analgesics
• Morning stiffness < 30 mins

Physical examination
• Examination findings limited to affected joints
• Tenderness around joint most common.
• Reduced ROM & crepitus frequently present
• Malalignment, muscle atrophy around joint
• Heberden nodes and bouchard nodes present
• Mostly in DIP, characteristic in women

Pain in OA
• Worst with use and improves with rest
• Divided into 2 types:
A) Dull aching, constant throbbing pain
a/w stiffness aka “Gelling Phenomenon”
B) Intense unpredictable pain for short duration,
emotionally traumatizing and limits activity
• Based on pain clinically classified as i)early OA
ii) mid OA
iii) Advanced OA
Source: Aboulenain S, Saber AY. Primary Osteoarthritis. StatPearls [Internet]. 2020 Dec 2

OA Pain Progression
• Early OA: Predictable sharp pain,
triggered by mechanical stimulus,
limits patient’s high impact activities
• Mid OA: Above described pain + unpredictable joint locking
pain increasingly more constant, affects dailly activity
• Advanced OA: constant dull aching pain
+
intermittent short episodes of unpredictable intense pain
avoids engagement in recreational/social activities.
Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R. Understanding the pain
experience in hip and knee osteoarthritis–an OARSI/OMERACT initiative. Osteoarthritis and cartilage. 2008 Apr 1;16(4):415-22.

Differential diagnosis
• A)Condition affecting soft tissue around joint
-Bursitis, Tendinitis
-Ligamentous instability
• B)Other forms of arthritis
-Gout and Pseudogouts
• C) Referred pain
-neuropathy
-radiculopathy
• D) Others

Diagnosis
• History, Clinical features and physical examination
• Radiological examination
-plain conventional radiograph/ X rays
-MRI
-ct scan
• Blood investigation
ESR, CRPH, RA factor, anti CCP, ANA
• Joint Fluid Analysis

X rays:
• First line and easiest method for diagnosis
• Joint space narrowing
• Osteophytes
• Articular irregularity and/or sclerosis
• Subcortical cysts(geodes)
• Intraarticular loose bodies

Joint space narrowing
• measured as maximum height of JSW
mid-portion of medial & lateral compartments of knee
• radiolucent area between the radiopaque margins
• 3 measurements made to nearest 0.1 mm
• In-built electronic caliper used.
• mean of the three recorded as JSW
Source: Anas I, Musa TA, Kabiru I, Yisau AA, Kazaure IS, Abba SM, Kabir SM. Digital radiographic measurement of normal knee joint space in adults at Kano, Nigeria.
The Egyptian Journal of Radiology and Nuclear Medicine. 2013 Jun 1;44(2):253-8.

Articular irregularity and/or sclerosis

Scoring system
• Kellgren and Lawrence Grading system
• Ahlback radiographic grading scale
• Brandt radiographic grading scale
• Osteoarthritis research society international(ORASI) atlas

Kellgren and Lawrence Grading System
Source: Audrey HX, Abd Razak HR, Andrew TH. The truth behind subchondral cysts in osteoarthritis of the knee. The open orthopaedics journal. 2014;8:7.

Ahlback radiographic grading scale
Source: Köse Ö, Acar B, Çay F, Yilmaz B, Güler F, Yüksel HY. Inter-and intraobserver reliabilities of four different radiographic grading scales of osteoarthritis of the knee joint.
The journal of knee surgery. 2018 Mar;31(03):247-53.

Brandt radiographic grading scale

Osteoarthritis research society
international(ORASI) atlas

MRI
• Not done routinely, detects earliest cartilage changes.
• Aggrecan when depleted, negative charges less homogeneous and diminishes
• delayed gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC)
• Measures T1 relaxation time of cartilage
• Gd-DTPA & proteoglycans negatively charged
• Thus concentration depends on proteoglycan content.

MRI scoring system for OA
• Knee
-Whole organ MRI score
-Knee OA scoring system
-Boston Leeds OA knee Score
-MRI OA knee score
• Hip
-Hip OA MRI scoring system
• Hand
-Oslo hand OA MRI score

CT scan
• For further planning of surgical procedures
• Outline bone and osteophytes
• Access bone alignment, deformity, position.

Other diagnostic modalities
• USG
• Joint fluid analysis
• Arthroscopy
• Blood and Serological investigation
• OCT(optical coherence tomography)
-arthroscopic measure
-captures cross-sectional echographs of IR light
-acquires near real time image of articular cartilage
Jahr H, Brill N, Nebelung S. Detecting early stage osteoarthritis by optical coherence tomography?.
Biomarkers. 2015 Nov 17;20(8):590-6.

Treatment modalities
• A) Lifestyle modification
• B)Pharmacotherapy
-Intraarticular steroid and hyaluronic acid injection
-Doxycycline( inhibitors of MMP)
-Recombinant human BMP and FGF
• C) Splints and immbolization
• D) Surgery and joint replacements

Hip joint OA
• 2nd to knee, largest weightbearing joint
• Process involves
-Progreesive loss of articular cartilage,
-Subchondral cyst, osteophyte formation
-periarticular ligamentous laxity, muscle weakness
-synovial inflammation
• Pain, reduced mobility, stiffness
• Men> women before 50, vice versa after 50.

Source:Murphy NJ, Eyles JP, Hunter DJ. Hip osteoarthritis: etiopathogenesis and implications for management. Advances in therapy. 2016 Nov;33(11):1921-46.

FAI and OA hip
• Femoro acetabular impingement - hip OA
• 3 distinct mechanism
-A) Cam FAI, focal/general overcoverage of femoral head by acetabulum
B) Pincer FAI, abnormal/aspherical morphology of proximal femur
-C) Mixed
• abnormal contact results in supraphysiologic stress,
tears the acetabular labrum,
delaminates acetabular articular cartilage from underlying bone
• Seen on AP radiograph- Pistol Grip Deformity
Source: Pun S, Kumar D, Lane NE. Femoroacetabular impingement. Arthritis & rheumatology (Hoboken, NJ). 2015 Jan;67(1):17.

Clinical features
• Pain, deformity, stiffness and/or limp
• Inspection: posture, deformities, muscle atrophy
• Palpation:
• Tenderness at hip, posture, Gait
• Trendelenberg test, Supine(limb length)
• Range of motion:
• Early signs abduction and rotation.
• Later flexion, extension and adduction difficult.
• Painful at end ROM
• Crepitus with movement

Understanding the pain experience in hip and knee
osteoarthritis
• an OARSI/OMERACT initiative
• 40+ years with painful hip or knee OA obtained
• modified Patient Generated Index (PGI) was used
• 143 participants, Mean age- 69.5, 63.8% female, 93.7% caucassian
• 2 types of pain- dull aching, punctuating increasingly, constant over time
-intense, often unpredictable, emotionally draining pain
• Later, greatest impact on quality of life
Source: Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R. Understanding the pain experience in hip and knee osteoarthritis–an OARSI/OMERACT
initiative. Osteoarthritis and cartilage. 2008 Apr 1;16(4):415-22.

Outcome measures
• Commonly practised:
-Harris hip score, Knee society score(KSS)
-Oxford hip score
-Visual Analogue Score(VAS)
• Others:
- Algofunctional index (AFI)
-Intermittent and constant osteoarthritis pain index (ICOAP)
-Lequesne index
-International Hip Outcome Score
-SF-36, HOOS, WOMAC

Management
• Medical Management :
-Primary Prevention, Physiotherapy
-Pharmacological (NSAIDS, Opoids)
-Intraarticular Injection(Steroid, HA, PRP, DMOD)
• Surgical Management:
-Hip Resurfacing
-Hip Osteotomies
-Joint preserving surgery
a)Arthroscopic debridement
b)Surgical dislocation with offset reconstruction
-THR

Intra-articular Injections Triamcinolone vs Ketorolac
• Pain relief, improved function, and potentially delay joint replacement
• Corticosteroid antinflammatory effect, but delay joint replacement
• Steroid a/w infection rate & subsequent arthroplasty
• double-blinded, randomized, noninferiority study
-5 mL of 0.5% ropivacaine with 80 mg of triamcinolone or 30 mg of ketorolac used
-120 patients, 77 female & 43 male
• Similar results on outcome score and pain relief.
Source: Jurgensmeier K, Jurgensmeier D, Kunz DE, Fuerst PG, Warth LC, Daines SB. Intra-articular injections of the hip and knee with triamcinolone vs ketorolac: a randomized controlled trial. The Journal of
Arthroplasty. 2021 Feb 1;36(2):416-22.

Exercise for weight management in obese adults
at risk for osteoarthritis
• Identify principles of exercise interventions, a RCT, non exercise control
• Age 18-50, outcomes -physical function, musculoskeletal pain, body composition
• Exclusion- perimenopausal, cancer, obesity related comorbidities
• Observation - similarities in exercise intensity(40-80% v02 max)
- frequency( 3 times per week), duration(30-60min)
-exercise mode (treadmill, cross-trainer, stationary bike, aquatic exercise)
• Conclusion – moderate intensity, 30-60 min
- 3-4 times a week
- effective for weight management, obesity-related musculoskeletal symptoms.
• Recommended to low risk, part of secondary prevention

THR ( Total Hip Replacement)
• Indication: End-stage OA-Hip
• Severe pain and limitation in dailly activities
• removal of head, neck of femur
acetabular cartilage and subchondral bone
• Cemented and Uncemented type
• Fixation: Cemented-PPMA,
Uncemented-bony ingrowth

Knee OA
• Most common joint affected
• Modified hinge joint: patellofemoral, tibiofemoral
• Complexity of joint, major weightbearing
• Similar etiopathogenesis, joint element involvement

Clinical features
• Pain with Movement, stiffness < 30 mins
• Reduced ROM, Antalgic gait,
• Inability to perform dailly activities
• Medial Joint line tenderness, swelling
• Crepitus on movement present
• Patellar grind test positive

Diagnosis and management
• Physical examination
• X-ray
• Arthroscopy
• MRI- detect early abnormalities
• CT scan

Treatment
• Medical Management :
-Primary Prevention, Physiotherapy
-Pharmacological (NSAIDS, Opoids)
-Intraarticular Injection(Steroid, HA, PRP, DMOD)
• Surgical management:
-Arthroscopy
-High tibial Osteotomy
-Patellofemoral joint arthroplasty
-Unicompartmental knee arthroplasty
-TKR

TKR
• Indication: End Stage OA- Knee
• Pain, functional limitation in end stage OA
• Prosthesis used
- Non Constrained
- Semi Constrained (2 types
- Constrained
• Holding prosthesis -cemented
-uncemented
-hybrid fixation
• Associated complication

Current Concepts in Osteoarthritis of the Ankle: Review
• Commonly Post traumatic, young, a/w obesity
• Nonspecific symptoms -stiffness, swelling, and pain
• weight-bearing standard views-AP, lateral, mortise, hindfoot
• Non operative measure used
• Viscotherapy with HA most evidence based, safe, efficacious
• Surgery for moderate to severe ankle OA
Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. Current concepts in osteoarthritis of the ankle. Surgical technology international. 2019 Nov 1;35:280-94.

OA of shoulder joint
• Gradual Wearing, pain, stiffness, Reduced ROM
• Subchondral bone remodels, loses sphericity and congruity
• Risk factors- H/o shoulder dislocation, overload, overhead sports
 Classified as – primary
- secondary (post inflammatory, post surgical,
posttraumatic, atraumatic osteonecrosis)
 Walch classification, to stratify the outcomes of shoulder arthroplasty
 Early disease nonoperatively managed, surgery reserved
for advanced disease.
Source: Chillemi C, Franceschini V. Shoulder osteoarthritis. Arthritis. 2013;2013.

Samilson Prieto grading of shoulder OA

Walch classification of glenoid morphology
• type A: centered humeral head, concentric wear, no subluxation of the humeral head
• A1: minor central erosion
• A2: major central erosion, humeral head protruding into the glenoid cavity
• type B: humeral head subluxated posteriorly, biconcave glenoid with asymmetric wear
• B1: narrowing of the posterior joint space, subchondral sclerosis, osteophytes
• B2: biconcave aspect of the glenoid with posterior rim erosion and retroverted glenoid
• B3: monoconcave and posterior wear with >15° retroversion or >70% posterior humeral head subluxation, or both
• type C
• C1: dysplastic glenoid with >25° retroversion regardless of the erosion
• C2: biconcave, posterior bone loss, posterior translation of the humeral head
• type D
• glenoid anteversion or anterior humeral head subluxation <40
Source: Vo KV, Hackett DJ, Gee AO, Hsu JE. Classifications in brief: Walch classification of primary glenohumeral osteoarthritis. Clinical Orthopaedics and Related Research®. 2017 Sep;475(9):2335-40.

Diagnosis
• X rays
-AP view
- Lateral/ Y view
- Grashey (AP oblique)
- Axial view
- Axillary view

Other radiological investigation
• Ct scan- bony changes, claasication, surgical plannig
• MRI- shows early changes in articular cartilage wear.
-anatomical and tissue speciific imaging
- evaluation of muscle atrophy, for appropriate therapy

Treatment option
• Early stage of disease:
-Non surgical approach- Rest, Physiotherapy, Exercise,
NSAIDS( COX-2 inhibitors)
-Intrarticular injections
• Advanced disease: Managed Surgically
- Arthroscopic Debridement with Capsular release
- Corrective osteotomies
- Arthrodesis
- Arthroplasty( Pain and functional limitations)

Surgical treatment of shoulder OA

Glenohumeral resurfacing
• Young patient with end stage osteoarthritis
• objective of maintaining native anatomy and bone stock
• hemi-cap implant for humerus, inlay polyethylene glenoid
• Beach chair position with deltopectoral approach
• Doesnot address soft tissue pathology as rotator cuff deficiency.
• Post op- placed in abduction 4 weeks & non weightbearing

Advantages of humeral resurfacing to conventional
shoulder arthroplasty
• no osteotomy performed (head-shaft angle not addressed);
• minimal bone resection
• a short operative time
• a low prevalence of humeral periprosthetic fractures;
• ease of revision to a conventional total shoulder replacement
Source: Burgess DL, McGrath MS, Bonutti PM, Marker DR, Delanois RE, Mont MA. Shoulder resurfacing. JBJS. 2009 May 1;91(5):1228-38

Hand OA
• most common site include DIP, PIP & thumb saddle joint.
• C/f: swollen, tender PIP, diffuse, swollen, fusiform joint
• Associated with Herberden’s and Bouchard’s node
• Joint stiffness correlates with degree of swelling
• CT for planning of surgery
• Operative technique joint replacement or arthrodesis.

Herberden an Bouchard nodes
• Potential window at PIP, DIP
• Lack of window at MCP
• Initial pain and inflammation
• Residual hypetrophic bone growth
• Women > men, a/w Genetics.
.
Source: Alexander CJ. Heberden’s and Bouchard’s nodes. Annals of the rheumatic diseases. 1999 Nov 1;58(11):675-8

Splintage and immobilization for hand OA
• Short dynamic hinge splint for collateral ligament
• Long dynamic splint with isometric outtrigger
-optimal distribution of forces to PIP in flexion/extension

American College of Rheumatology criteria for
osteoarthritis of the hand
• Hand pain, aching or stiffness most days of prior month + 3 of 4 criteria:
-Hard tissue enlargement of ⩾2 of 10 selected hand joints*
-Metacarpophalangeal joint swelling in ⩽2 joints
-Hard tissue enlargement of ⩾2 distal interphalangeal joint joints
-Deformity of ⩾1 of 10 selected hand joints
(*The 10 selected hand joints include bilateral second and third DIP joints, second and third
proximal interphalangeal joints and first carpometacarpal joints.)
Source : Altman R, Alarcon G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Gray R, Greenwald R. The American College of Rheumatology criteria for the
classification and reporting of osteoarthritis of the hand. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 1990 Nov;33(11):1601-10.

Surgical approach for Hand OA
• Dorsal approach: Widely used
• Volar approach:
-theoretically advantageous over others
-technically demanding, less space for
replacement surgery
• Lateral approach: least common for PIP
Herren D. The proximal interphalangeal joint: arthritis and deformity. EFORT
open reviews. 2019 Jun;4(6):254-62.

Surgery for hand OA
Fig: Pip arthroplasty with surface replacement
Fig: silicon pip arthroplasty
Fig: Subsequent PIP arthroplasty with a silicone implant.
Fig: PIP fusion with tension band wiring
Fig: Single screw fixation of PIP fusion
Source: Herren D. The proximal interphalangeal joint: arthritis and deformity. EFORT open reviews. 2019 Jun;4(6):254-62.

Facet Joint OA(FJ-OA)
• 3 joint complex: facet joint involved
• disc degeneration, Weight transmission via FJ
• FJ-OA most common L4-S1
• Osteophytes, spinal stenosis, Pain & Radiculopathy, wasting
• Decrease paraspinal bulk & canal stenosis
• Adult Degenerative Scoliosis & Degenerative Spondylolisthesis
Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, Heck O, Boubagra K, Grand S, Krainik A. Facet joint syndrome: from diagnosis to interventional management. Insights into imaging. 2018 Oct;9(5):773-89.

Gellhorn AC, Katz JN, Suri P. Osteoarthritis of the spine: the facet joints. Nature Reviews Rheumatology. 2013 Apr;9(4):216-24.

Managemement of spinal osteoarthritis
• Lifestyle modification, weight reduction, analgesics
• Rest, Excercises, Braces
• Corticosteroids injection into joints
• TENS (Transcutaneus Electric Nerve Stimulation)
• Surgery
- Total disc replacement surgery(CI in FJ-OA)
- Instrumented fusion ( prevents instability)
- Laminectomy for canal stenosis

Corticosteroid injection into joints
-Patient positioned lateral/prone
-Local anesthetics + steroids
injection into joints
-AP and Lateral Fluroscopic
guidance
-Symptomatic relief of
radiculopathy
Source : C arm images, trauma OT

Total disc replacement

Instrumented fusion
• Done for degenerative spondylolisthesis in AIIMS, Rishikesh
• To stop motion at painful joint.

Studies on the Role of circRNAs in Osteoarthritis
• mechanism of circRNAs regulating OA and treatment.
• Noncoding mRNA without 5′-3′ polyadenylated nor polarity tail
• interfere chondrocytes proliferation,apoptosis,
ECM degradation, inflammation
• 31 circRNAs were included in PPI, GO, and KEGG analyses
• 27 circRNA upregulated, 7 circRNA downregulated in OA
• used as biological indicator to detect OA in clinical practice.
Source: Wu W, Zou J. Studies on the Role of circRNAs in Osteoarthritis. BioMed Research International. 2021 Sep 6;2021

Platelet-rich plasma versus hyaluronic acid in the treatment
of knee osteoarthritis: A meta-analysis
• 4 RCTs involving 1350 patients included.
• AS, IKDC, WOMAC-Pain, WOMAC-Stiffness, WOMAC-Physical Function, and
WOMAC-Total scores
• PRP group score > HA group
• PRP upper hand over HA in knee OA
• Improves knee joint function, reduce long term pain
• Can be usef dor conservative management
Chen Z, Wang C, Di You SZ, Zhu Z, Xu M. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. Medicine. 2020 Mar;99(11).

Gut microbiota modulation and its impact on OA
• link between thegut microbiome and development of OA
• probiotics and/or prebiotics or symbiotic used to modulate
• Mechanism still unclear
Source: Arora V, Singh G, InSug O, Ma K, Anbazhagan AN, Votta-Velis EG, Bruce B, Richard R, van Wijnen AJ, Im HJ. Gut-microbiota modulation:
The impact of the gut-microbiota on osteoarthritis. Gene. 2021 Jun 15;785:145619.

MMP-13
• MMP-13 ECM degrading enzyme in OA
• Level correlates pathologic chondrocytes hypertrophic differentiation
• 24 different MMP genes, 23 MMP proteins
• MMP-13 increased in stress induced OA
• HMW-HA shown to inhibit production of MMP-1,3,13
• MMP inhibitors- new hope for OA Treatment.
Source: Hu Q, Ecker M. Overview of MMP-13 as a Promising Target for the Treatment of Osteoarthritis. International Journal of Molecular Sciences. 2021 Jan;22(4):1742.

Osteoarthritis Scenario in India
• Epidemology - Most frequent joint disease, 22-39 %
- women> men, 45% of women over 65 years with symptoms
radiological evidence in 70% over 65 years
- OA knee major cause of mobility impairment, particularly females
- 10th leading cause of nonfatal burden
Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A. Epidemiology of knee osteoarthritis in India and related factors. Indian journal of orthopaedics. 2016 Oct;50(5):518-22.

Osteoarthritis Scenario in India
• BMI and OA:
• Activity level and OA

References for presentation:
• The proximal interphalangeal joint: arthritis and deformity(Daniel Harren)
• Cervical Osteoarthritis (Cervical Spondylosis) Medically Reviewed by David Zelman, MD on June 03, 2020
• Spinal Osteoarthritis, Thomas Lindsey; Alexander M. Dydyk.
• Osteoarthritis of the spine: the facet joints Alfred C. Gellhorn, Jeffrey N. Katz, and Pradeep Suri
• Hip Osteoarthritis: A Primer, Michelle J Lespasio, DNP, JD, ANP
• The epidemology of Osteoarthritis, Victoria L Johnson et al, feb 2014
• The etiology of osteoarthritis of the hip: an integrated mechanical concept Reinhold Ganz 1, Michael Leunig, Katharina Leunig-Ganz, William H Harris
• Overview of MMP-13 as a Promising Target for the Treatment of Osteoarthritis Qichan Hu , Melanie Ecker
• Intra-articular Injections of the Hip and Knee With Triamcinolone vs Ketorolac: A Randomized Controlled Trial
• Kevin Jurgensmeier 1, Darin Jurgensmeier 2, Derek E Kunz 2, Peter G Fuerst 3, Lucian C Warth 4, Steven B Daines 2
Affiliations expand, PMID: 32950343 , DOI: 10.1016/j.arth.2020.08.036

• Shoulder Osteoarthritis-pathogenesis, classification, diagnostics and treatment]
Mark Tauber, Frank Martetschläger, PMID: 31432200, DOI: 10.1007/s00132-019-03792-9
• Gut-microbiota modulation: The impact of thegut-microbiotaon osteoarthritis
Vipin Arora 1, Gurjit Singh 2, InSug O-Sullivan 3, Kaige Ma 2, Arivarasu Natarajan Anbazhagan 3, E Gina Votta-Velis 4, Benjamin Bruce 5, Ripper Richard 6, Andre J van
Wijnen 5, Hee-Jeong Im 7
• Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: A meta-analysis
Zehan Chen 1, Chang Wang 1, Di You 2, Shishun Zhao 1, Zhe Zhu 3, Meng Xu 4
• Studies on the Role of circRNAs in Osteoarthritis
Wei Wu 1, Jun Zou 1
• Efficacy of commonly prescribed analgesics in the management of osteoarthritis: a systematic review and meta-analysis
Mohan Stewart 1 2, Jolanda Cibere 3 4, Eric C Sayre 3, Jacek A Kopec 3 5
• Circular RNAs in osteoarthritis: indispensable regulators and novel strategies in clinical implications

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osteoarthritis.pptx

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