Osteoarthritis

Osteoarthritis A presentation by Akpanusong Kubiat Okon.

group 3, 6th course, medical faculty

Osteoarthritis is a condition that affects your joints. The surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should.

Osteoarthritis (also known as OA) is a common joint disease that most often affects middle-age to elderly people. It is commonly referred to as "wear and tear" of the joints, but we now know that OA is a disease of the entire joint, involving the cartilage, joint lining, ligaments, and bone  Osteoarthritis (OA, osteoarthrosis or degenerative joint disease) is not a single disease. Rather it is the end result of a variety of patterns of joint failure. To a greater or lesser extent it is always characterised by both degeneration of articular cartilage and simultaneous proliferation of new bone, cartilage and connective tissue.

CAUSES/RISK FACTORS

• Old age • Genetics • Obesity• Trauma or surgery• Female gender

SYMPTOMS

• PAIN: severe pain causing loss of ability is the main symptom of osteoarthritis, sharp burning sensation pain

• Stiffness: mainly occurring in the morning and is relieved by activity

• Crepitus : a grating or grinding sensation

• Swelling

• Decreased range of motion

• Inflammation

CLASSIFICATION

• PRIMARY OR IDIOPATHIC

• SECONDARY: traumatic, congenital, metabolic, endocrine, neuropathic and other medical causes

• Focal and progressive loss of hyaline cartilage of joints : under- lying bony changes

JOINTS MOSTLY AFFECTED

• Knees• Hips• Hands• Neck• Big toe • Spine

Laboratory and instrumental findingsThe diagnosis of OA is usually based on clinical and radiographic features. In the early stages, the radiograph may be normal but joint space narrowing becomes evident as articular cartilage is lost. Other characteristic findings include subchondral bone sclerosis, subchondral cysts, and osteophytosis. A change in the contour of the joint, due to bony remo-deling, and subluxation may be seen. Although tibiofemoral joint space narrowing has been considered to be a radiographic surrogate for articular cartilage thinning, joint space narrowing alone does not accurately indicate the status of the articular cartilage in patients with early OA who do not have radiographic evidence of bony changes (e.g., subchondral sclerosis or cysts, osteophytes).The Kellgren-Lawrence grading systemis radiological classification osteoarthritis. It is based on x- rays and consists of normal, Grade I, Grade II, Grade II and Grade IV.This categorical scale incorporates important radiographic features of osteoarthritis:

· Joint space narrowing – bone is visible on x-ray but the articular cartilage that covers it is not. A normal joint therefore appears to have a space between the bones. Any decrease in space implies a reduction in cartilage cover.· Osteophytes - small bony projections that from around joint margins. They are responsible for limiting range of motion and can cause pain.· Sclerosis – this means ‘hardening’ and is a sign of osteoarthritis, seen as increased white areas in the bone at the joint margins.

• Joint aspiration. The doctor will numb the affected area and insert a needle into the joint to withdraw fluid. The fluid will be examined for evidence of crystals or joint deterioration. This test can help rule out other medical conditions or other forms of arthritis.

• MRI. Magnetic resonance imaging (MRI) does not use radiation. It is more expensive than X-rays, but will provide a view that offers better images of cartilage and other structures to detect early abnormalities typical of osteoarthritis.

Treatment No single treatment is considered sufficient for managing OA. The consensus is that a multifaceted approach that involves both nonpharmacological and pharmacological therapies should be used, especially for weight-bearing joints, where mechanics and lifestyle play a significant role in determining the symptoms.Nonpharmacological treatments should form the basis of any OA regimen, but they often are underutilized and underemphasized.

• lifestyle change: healthy diet, reduce fat, sugar and salt intake excersice • heat and cold therapy: using ice packs help to reduce swelling and pain

• Medication: NSAIDS: ibuprofen, diclofenac Acetaminophen

Hyaluronan Injections (Viscosupplementation)

corticosteroid injections

Surgery:

If the above management is ineffective, joint replacement surgery may be required. Individuals with very painful OA joints may require surgery such as fragment removal, repositioning bones, or fusing bone to increase stability and reduce pain. Surgical intervention for osteoarthritis of the knee may be no better at relieving symptoms.