Osteoarthritis is a degenerative joint disease characterized by progressive loss of articular cartilage. Risk factors include age, obesity, joint injury, genetics, and occupation. Symptoms include joint pain, tenderness, and stiffness. Treatment focuses on reducing pain and inflammation through measures like exercise, weight loss, bracing, oral medications, and injections. Surgery is considered if more conservative treatments fail to improve function and quality of life.

3.  Diagnosis of Osteoarthritis
 Risk factors for Osteoarthritis
 Treating active persons with Osteoarthritis

4. Disease of the joints
characterized by:
– Progressive articular
cartilage loss
– New subchondral bone
formation
– New bone and cartilage
formation at joint
margins
– Low level synovitis
& PAIN!

5.  OA is a group of diseases and mechanical
abnormalities entailing degradation of joints,
including articular cartilage and the subchondral bone
next to it
 OA is derived from the Greek word ‘ostoe’, meaning
‘of the bone’, ‘arthro’, meaning ‘joint’, and ‘itis’,
meaning inflammation

6.  Also known as degenerative
joint disease or “wear and
tear arthritis”.
 Progressive loss of cartilage
with remodeling of
subchondral bone and
progressive deformity of the
joint (s).
 Cartilage destruction may be
a result of a variety of
etiologies

7.  Joint space narrowing
 Subchondral sclerosis
 Marginal osteophytes
 Subchondral cyst

12.  Joint trauma
 Age  Obesity (knee, hip,
 10-fold increase from 3065
hand)
 Occupation
 Genetics (generalized)
 Abnormal joint
 Gender
biomechanics
 Men <50: higher risk  Dysplasia, malalignment,
 Women >50: higher risk instability, abnormal
innervation
 Nutritional
 Low vitamin C and D intake
 Knee extensor wkness
 Sports w/ joint risk
Systemic Risk Factors Joint Biomechanical Risk Factors

13.  Obesity
 Heredity
 Gender
 Hypermobility
 Osteoporosis
 Trauma
 Congenitaljoint dysplasia
 Occupation
 Sport

14. Primary OA: No known cause
Secondary OA
 Pre-existing joint damage:
RA, Gout, Seronegative spondyloarthropathy, Septic
arthritis, Paget's disease, Avascular necrosis, e.g.
corticosteroid therapy
 Metabolic disease: Chondrocalcinosis, Hereditary
haemochromatosis, Acromegaly
 Systemic diseases: Haemophilia- recurrent
haemarthrosis, Haemoglobinopathies, e.g. sickle
cell disease, Neuropathies

15. Signs
 Joint tenderness
 Crepitus on movement
 Limitation of range of movement
 Joint instability
 Joint effusion and variable levels of
inflammation
 Bony swelling
 Wasting of muscles.

16. Generally speaking, the process of
clinically detectable osteoarthritis is
IRREVERSIBLE
and typical treatment consists of
medication or other interventions
that can reduce the pain of OA and
thereby improve the function of the
joint

17.  Non pharmocologic Measures
 Education, Weight loss, Exercise, & Bracing
 Pharmacologic Measures
 Analgesics, Glucosamine, Injectables
 Alternative Therapies
 Acupuncture, Magnets, Balneotherapy, Thermotherapy
 Surgery

18.  Weight control
 Appropriate rest and Exercise
 Physical therapies
 Occupational therapies

19.  Medial or lateral unloading

20.  Glucoseamine, chondroitin sulphate, antioxidants,
others…
SPECIFIC MEDICATIONS
 Paracetamol
 NSAIDs
 COX-2 selective inhibitors
 Corticosteroids

21.  I recommend in ALL patients with knee and hip OA
 GS 1500 mg/ CS 800 mg
 3 month trial, evaluate efficacy; continue if
helping
 Consider indefinite use even if no pain relief for
joint space preservation

22. Based on research dating back to the 1980’s
 Increases the viscosity and elasticity of OA
synovial fluid
 Stimulates endogenous hyaluronic acid
production
 Inhibits induction and activity of degradative
enzymes
 Reduces inflammatory response
 Analgesic effect

23.  TENS effective in some with knee or hip OA
 Short-term, 2-4 weeks
 Acupuncture relieves pain
 Heat/Ice thermotherapy
 Balneotherapy

24.  Arthroscopy
 Cartilage transplantation
 Joint replacement

25.  NOBENEFIT for unselected OA
(mechanical or inflammatory
causes)

26.  Universally
recommended to
improved pain, function, QOL
 Unicompartmental
 Total joint replacement

27.  Implantation of chondrocytes
 Local injection of hyaluronic acid
 Topical treatment
 Surgical treatment
 Acupuncture