2. What is Arthritis?
Acute or chronic inflammation of a joint, often
accompanied by pain and structural changes and having
diverse causes, as infection, crystal deposition, or injury
3. Osteoarthritis
Osteoarthritis is non inflammatory degenerative
condition of joints characterized by degeneration of
articular cartilage and formation of new bone i.e.
osteophytes.
5. •Affect DIP, PIP, 1st
Carpometacarpal, knee, hip,
spine
Primary OA
(Idiopathic)
•Affect less common joint as
wrist, metacarpophalangeal,
shoulder.
Secondary
OA
Types of Osteoarthritis
6. Risk Factors
PRIMARY
Age
Gender
Obesity
High Bone Mass
Mechanical : Repetitive
bone use squatting
SECONDARY
Injury to joint : Traumatic or
inflammatory
Heamoartharosis
Congenital/Developmental
Neuropathic joint
Metabolic (Paget's Disease)
7. Macro structural & Pathological Changes
Macro structural
Loss of articular cartilage
Subchondral cyst
Osteophytes
Sclerosis
Muscle wasting
Pathological
Cartilage Fibrilation
Subchondral new bone
Myxoid degeneration
Trabecular compression
8. Sign & Symptoms
• Pain
• Tenderness
• Stiffness
• Loss of flexibility
• Grating sensation
• Crepitus
• Bone spurs
9. Knee OA
The classical criteria for OA of knee
is based upon the presence of knee
pain plus at least 3 of the following
6 clinical characteristics
1. Age >> 50 years
2. Morning stiffness for < 30
minutes
3. Crepitus on active motion of
knee
4. Bony tenderness
5. Bony enlargement
6. No palpable warmth
10. Hand OA
The classical criteria for OA of hand is based
upon the presence of hand aching or stiffness
plus at least 3 of the following 4 features
1. Hard tissue enlargment of 2 or more of 10
selected joint. The 10 selected joints are
the second and third distal
interphalangeal (DIP) joints, second and
third proximal interphalageal (PIP) joints
and the first carpometacarpal (CMC) of
both hands.
2. Hard enlargement of two or more DIP
joints.
3. Fewer than 3 swollen
metacarpophalangeal (MCP) joints.
4. Deformity of atleast 1 of the 10 selected
joints.
11. Hip OA
The presence of hip pain plus
at least two of the following 3
features
1. ESR of less than 20mm/h
2. Radiographic osteophytes
(femoral or acetabular)
3. Joint space narrowing on
radiography (superior,
axial or medial)
12. Spine OA
Most common at C5, T8 and L3
1. OA of spine is a
breakdown of the
cartilage of the joints and
discs in the neck and
lower back.
2. OA produces spurs that
put pressure on the
nerves leaving the spinal
column.
15. Therapeutic Approach to Osteoarthritis
Acetaminophen
Dose 650 to 1000 mg up to 4
times per day
NSAID Therapy
Short acting NSAIDs
(ibuprofen )
Long acting NSAIDs
(diclofenac , naproxen ,
nabumetone) – greater relief
COX2 inhibitors (celecoxib)
Opioids
Only when acetaminiphen or
NSAIDs fail
Starts with low dose
Tramadol and Duloxetine
Diacerein
Blocks interleukin-1
Disease modifier for OA.
Daicerein increase proteoglycans
and hyaluronan
19. Complementary and Alternative
Medicines
• Intra articular injection for corticosteroids or
hyaluronic acid
• Acupuncture
• Heat and Cold
• Glucosamine/Chondroitin
• Synovial Fluid Supplements
• Capsaicin Cream
• Diclofenac Gel