2. Osteoarthritis (OA)
OA is a progressive irreversible disease characterized by
the degradation of articular cartilage.
Cartilage becomes pitted and frayed at the surface and
becomes increasingly inelastic.
As OA progresses, loss of cartilage increases and may wear
away completely leaving the bone ends exposed and able to
rub together.
Pieces of cartilage and/or bone may break off into the
synovial fluid.
Most common & most frequent of the disabling joint
disorders
Classified as primary (idiopathic) or secondary, resulting
from previous joint injury or inflammatory disease
3. Classification of OAClassification of OA
• Primary OA
▫ Most common form
▫ Is rare before age 40 years,
prevalence increases
with age
▫ Knee joint most often affected
▫ Genetic predisposition,
particularly for hand arthritis
• Secondary OA
▫ Preceded by a predisposing
disorder such as joint trauma
▫ Occurs in any joint
Solomon L. 1997
4. Primary OA has no single specific cause but is generally
associated with aging, normal mechanical stresses and
genetic factors.
It usually occurs in weight-bearing joints that have undergone
abnormal stresses (e.g. from obesity or overuse), and is
frequently linked with increased age.
Common sites of involvement include the hands, hips, knees
and feet. Primary OA is the most common form of OA.
In contrast, secondary OA may occur in any joint at any age
and has an identifiable underlying cause (e.g. inflammatory
or metabolic disease).
Secondary OA develops following any process that damages
the joint such as fractures, dislocations, sports injuries, joint
surgery or repetitive trauma (occupational trauma).
5. Risk Factors of OA
Obesity,
↑ Age,
Joint injury,
stress on the joints from certain jobs and
playing sports
Genetics (Legg-Calve-Perthes disease)
6. Risk factors for primary OARisk factors for primary OA
OA
Obesity
Occupation
Old age
Family history
Genetics
Trauma
Joint
dysplasia
Bone injury
Gender
Joint injury
Solomon L. 1997
7. Osteoarthritis
Prevalence increases exponentially beyond
the age of 50 with about 80-90% of both
sexes having osteoarthritis by age 65.
Age-related changes include: alterations in
proteoglycans & collagen, which decrease
tensile strength & shorten fatigue life but it is
not simply a disease of wear and tear
10. Osteoarthritis (OA)
Begins in the 3rd
decade of life and peaks
between the 5th
and 6th
Direct correlation with age and the
degenerative process
11. Pathogenesis
• OA is a joint disease that mostly affects
cartilage.
• Cartilage is tissue that covers the bones in a
joint.
• Healthy cartilage allows bones to glide over
each other. It also helps absorb shock of
movement.
• In osteoarthritis, the top layer of cartilage breaks
down and wears away.
12. Pathophysiology
This allows bones under the cartilage to rub
together.
The rubbing causes pain, swelling, and loss of
motion of the joint. Over time, the joint lose its
normal shape.
Also, bone spurs may grow on the edges of the
joint.
13. Bits of bone or cartilage can break off and float
inside the joint space, which causes more pain and
damage.
People with osteoarthritis often have joint pain and
reduced motion.
Unlike some other forms of arthritis, osteoarthritis
affects only joints and not internal organs.
Rheumatoid arthritis - the second most common
form of arthritis - affects other parts of the body
besides the joints.
14. Osteoarthritis
Chondrocytes play a primary role and
constitute the cellular basis of the disease
They produce IL-1 & TNF-alpha, which are
known to stimulate the production of
catabolic metalloproteinases and inhibit the
synthesis of both type 2 collagen and
proteoglycans; other mediators also have a
role in matrix degradation
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Natural history of OA: Progressive cartilage
loss, subchondral thickening, marginal
osteophytes
16. Modest, patchy
chronic synovitis
Bone ends thicken
Bony outgrowths
(osteophytes) form
Bone fragments may float
in the joint space
Fluid filled cysts may form
in the bone
OA jointNormal joint
Cartilage:
Pitted and frayed surface
Loss of elasticity
Cartilage may wear away
completely
Thickening
of capsule
Characteristics of OACharacteristics of OA
Dieppe P. 1998
17. Clinical Manifestations OA
Stiffness in a joint after getting out of bed or
sitting for a long time
Last <30 min. and ↓ with movement
Swelling or tenderness in one or more joints
A crunching feeling or the sound of bone
rubbing on bone.
18. OA: Symptoms and Signs
• Pain is related to
use
• Pain gets worse
during the day
• Minimal morning
stiffness (<20 min)
and after inactivity
(gelling)
• Range of motion
decreases
• Joint instability
• Bony enlargement
• Restricted
movement
• Crepitus
• Variable swelling
and/or instability
19. Osteoarthritis
Is an insidious disease
Characteristic symptoms include: deep,
achy pain that worsens with use.
Impingement on spinal foramina by
osteophytes results in cervical & lumbar
nerve root compression with pain.
muscle spasms & atrophy & neurologic
deficits
20. Osteoarthritis
Typically, only one or a few joints are
involved
Joints commonly involved are: hips, knees,
lower lumbar & cervical vertebrae, proximal
& distal interphalangeal joints of fingers,
etc.
Heberden nodes: which common in
women, represent prominent osteophytes
in distal interphalangeal joints
21. Finger deformities in OAFinger deformities in OA
• Deformities occur at:
• The base of the thumb
(Bouchard’s nodes)
• The middle joint of a finger
(Bouchard’s nodes)
• The finger tip
(Heberden’s nodules)
Heberden’s nodules
in a patient with OA
Sciencephoto.com
25. The various changes in bone structure
associated with OA lead to a number of classical
deformities.
Muscle weakness and joint instability can result
in a shift in the parts of the joints that bear the
load.
This can lead to alterations in the joint shape,
as shown above, where the bones of the joint
are no longer correctly aligned.
26. Assessment and Diagnosis
Difficult to diagnose
Physical assessment
Tender enlarged joints
Inflammation
Progressive loss of cartilage appears on xray
Blood test are not useful
27. Medical Management Goals
Osteoarthritis treatment has four main goals:
Improve joint function
Keep a healthy body weight
Control pain
Achieve a healthy lifestyle
28. Medical Management of OA
Conservative treatment
Education
Use of heat
Weight reduction
Joint rest and avoidance of joint overuse
Orthotic devices
Isometric and aerobic exercises
Massage, yoga,
Occupational and physical therapy
29. Medical Management of OA
Alternative therapy
Herbal and dietary supplements
Acupuncture, acupressure
Copper bracelets or magnets
30. Pharmacologic Therapy
Symptom management and pain control
Medication selection
Patients needs
Stage of disease
Risk of side effects
Medications and other treatments
33. Surgical Management
Osteotomy- alter the distribution of weight
within the joint
Arthroplasty- disease joint components are
replaced with artificial products
Tidal irrigation- lavage (provides pain relief
for up to 6 months)
34. Nursing Management
Pain management
Optimal function
Patient’s understanding of disease
Lifestyle changes
Weight loss
Referrals
Assistive devices
35. Case: Carpometacarpal Joint
Radiograph shows
severe changes
Most common
location in hand
May cause
significant loss of
function
The prevalence of OA increases with age, rising from about 1% in those under 30 years to more than 70% in those over 70 years of age. Men and women are equally prone to OA, but more joints are affected in women.
Obesity is a significant risk factor for the development and progression of OA, particularly OA of the knee. Joint injuries due to trauma, or as a result of repetitive occupational activities, are also strongly associated with OA. Frequently, patients with OA will have a family history of the disease and there is often a similarity in the type of OA that develops among family members.
Reference
Solomon L. Clinical features of osteoarthritis. Textbook Rheum 1997;2:1383–1393.
Reference
Dieppe P, Lim K. Osteoarthritis and related disorders. Clinical features and diagnostic problems. In: Klippel J, Dieppe P, editors. Rheumatology. London: Mosby, 1998;3.1–3.16.
OA most commonly affects the knee, hip, fingers or spine. Less frequently, it may affect the joints of the elbow, shoulder, wrist or ankle.
Reference
Solomon L. Clinical features of osteoarthritis. Textbook Rheum 1997;2:1383–1393.
The various changes in bone structure associated with OA lead to a number of classical deformities. Muscle weakness and joint instability can result in a shift in the parts of the joints that bear the load. This can lead to alterations in the joint shape, as shown above, where the bones of the joint are no longer correctly aligned.
Reference
Dieppe P, Lim K. Osteoarthritis and related disorders. Clinical features and diagnostic problems. In: Klippel J, Dieppe P, editors. Rheumatology. London: Mosby, 1998;3.1–3.16.