OSTEOARTHRITIS

Abhishek B V
Roll no 03
• It is the most common form of arthritis in older
people
• Over the age of 45
• It is characterised by
– Focal loss of articular cartilage
– Subchondral osteosclerosios
– Osteophyte formation at the joint margin
– Remodeling of joint contour with enlargement of
effected joint
– Joint involvement ; hip joint ,knees, PIP ,DIP,
 Risk factors
• Heredity
• Ageing
• Gender ; like knee OA is more common among
females than males
• Obesity
• Trauma
• Occupation like farmers (hip joint)
 pathophysiology
• Chondrocytes divide to produce nests of
abnormally active cells
• Increased degradation of structural component of
cartilage like aggrecan and type 2 collagen
• Resulting in fissuring of the cartilage surface
forming deep vertical clefts
• Localised chondrocyte death results in focal loss
of articular cartilage
• Fibrocartilage is produced at the joint margin
which undergoes endochondral ossification to
form osteophytes
 Clinical features
• Symptoms ; pain and restricted movement
• Signs;
• Coarse crepitus on palpation
• Deformity ,
• Bony swelling around joint margins
• Restricted movement due to capsular
thickening or blocking by osteophytes
• Muscle weakness and wasting
 Generalised nodal OA
• Characteristics ;
• Polyarticular finger interphalangeal joint OA
• Heberden’s nodule in DIP and Bouchard’s
nodule in PIP joints
• Middle aged females
• c/f pain ,stiffness , swelling of PIP joints
• It also involves first carpometacarpel joint
 Knee OA
• Females > males
• It targets patello –femoral and medial tibio –
femoral components
• c/f ; pain localised to anterior and medial aspect
of the knee
• Antalgic gait
• Weakness and wasting of quadriceps muscle
• Restricted flexion and extension with coarse
crepitus
 Hip OA
• It is usually associate with generalised nodal
OA
• C/F ;pain deep in the anterior groin and
restricted internal rotation
• Antalgic gait
• Weakness and wasting of gluteal muscle
 Investigations
• Plain x-ray of effected joint
• In case of suspected nerve root compression
MRI
• Autoantibody tests
• Routine biochemistry and haematological
investigation
 Management
 Education like
• weight loss if overweight and muscle
strengthening exercises
 Analgesics and anti-inflammatory
• paracetamol with topical NSAID
if pain is severe opiates may be required
 Intra-articular corticosteroids are effective
treatment of knee OA
 Hyaluronan inj ;intra articular inj as a weekly
course for 3 to 5 weeks
• Disease – modifying therapies like
GLUCOSAMINE SULPHATE, DIACEREIN and
CYTOKINE INHIBITORS these will slow the rate
of radiological progression
• Surgery
Total joint replacement surgery ;It is indicated
in patient having severe pain and significant
structural damage on x ray