‫اسم الطالب ‪:‬عبدالمنعم عماد مصطفى عبدالحميد‬

‫رقم الجلوس ‪16266:‬‬

‫البريد الجامعي‪Abdalmonem160272@fmed.bu.edu.eg :‬‬

‫رقم التليفون‪01090365695:‬‬

‫الماده ‪Pathology :‬‬

‫عنوان البحث‪Osteoarthritis :‬‬

‫رقم التلفون‪01090365695:‬‬

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Abstract

This update is aimed at exposing the current pathophysiology and treatment as

osteoarthritis is:
the most popular type of joint disease, specifically targets the hips, knees, hands
and feet, leading to significant impairment and a lower quality of life, particularly among
the elderly. Its significance grows each year as the population ages, with a significant incr
ease in the elderly population compared to the younger patients.

Gradual understanding of OA's pathophysiology, the recognition that the mechanism is n

ot merely mechanical and/or aging, and clarification of the inflammatory pathways involv
ed recently led to clinical application of various drugs and other steps.

Introduction

Osteoarthritis ( OA) is the most common joint disease in the world, with both incidence
and prevalence increasing in age-associated cases .It is a leading cause of disability in many
countries, many reporting arthritis-attributable limitations of activity. Only depression and
abuse of alcohol contribute to the loss of more years to disability. Due to aging population
, rising obesity rates and high rates of traumatic knee injuries or any other causes , the
incidence and prevalence of OA is already predicted to skyrocket over the coming decades.
This is a public health issue, and comprehensive , high-quality clinical OA research is
urgently required to ensure patients receive safe and successful treatments. This paper is a
retrospective review of some of the most important research conducted in recent years on
osteoarthritis.(1)

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Definition of osteoarthritis :

Osteoarthritis ( OA) is by far the most prevalent type of arthritis worldwide. It can be
classified into two parts: primary arthritis and secondary osteoarthritis. Classically, OA
has joint pain and loss of control, but the condition is clinically very complex and may
only result in a debilitating and permanently impaired illness as an asymptomatic
incidental finding. (1) Fig 1 (2)

Fig1 : Pathogenic features consistent with osteoarthritis (“joint failure”)

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Types of osteoarthritis :

a) Primary OA is the most popular type of the disease and is diagnosed without a
predisposing trauma or disease but is correlated with the above-mentioned risk
factors.
b) Secondary OA occurs when joint abnormality pre-exists. Predisposing conditions
include trauma or injury, congenital joint disorders, inflammatory arthritis,
avascular necrosis, metabolic disorders , Paget 's disease, osteoporosis,
osteochondritis dissecans, infectious arthritis,hemoglobinopathy, Ehlers-Danlos
syndrome or Marfan 's syndrome(1)

Sites of osteoarthritis :

Mostly in hips in the male,

but in female mostly in knees and hands (3) fig2 (2)

Fig 2:Frontal x ray of knee showing advanced osteoarthritis

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Etiology (4) :

a) Aging :
Age is one of the most prevalent risk factors for OA,
a large number of people over the age of 65 have been diagnosed with radiographic
changes in one or more joints. In addition to
cartilage, ageing affects other joint tissues, including synovium,
subchondral bone and muscle, which is known to lead to changes
in joint load,studies using articular chondrocytes and other cells
indicate that aging cells exhibit elevated oxidative stress that
causes cell senescence and changes mitochondrial function.
b) Obesity: Obesity has become a worldwide epidemic in recent years,
characterized by an increased adipose tissue composition in the body.
There has long been awareness of the relationship between obesity and OA. Obesit
y patients experience earlier OA and have more serious symptoms, increased ris
k of infection, and more technical challenges for complete joint replacement surger
y.
In addition to increased biomechanical loading on the knee joint, obesity is thoug
ht to lead to low–grade systemic inflammation by secreting cytokines, called
adipokines, that are derived from adipose tissue. Niveaus of pro-
inflammatory cytokines in particular.

There’re many other risk factors such as sports injuries, inflammation and genetic
predisposing that may increase the chance of osteoarthritis(5).

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Pathogenesis :

Intrinsic biochemical and metabolic alterations of the cartilage result in the release of
chemical mediators from chondrocytes resulting in cartilage matrix breakdown(3,4)

Pathological Features :The OA 's appearance and development differs greatly

between individuals(1).

1) Cartilage : because of the massive destruction found in pathological specimens

and image studies, and because of the large amount of activated biological
processes in it, the cartilage traditionally receives the main attention in OA studies.
Key events in the cartilage include metabolic unbalance and the emergence of
indicators of degradation, promoted by cytokine cascades and inflammatory
mediator. In OA patients, chondrocytes and synovial cells develop increased levels
of inflammatory cytokines such as interleukin 1β (IL-1β) and alpha tumor necrosis
factor (TNF-α), which in turn decrease collagen synthesis and increase catabolic
mediators such as metalloproteases (MMPs) and other inflammatory substances
such as interleukin 8 (IL-8), interleukin 6 ( IL-6), prostaglandinin. Furthermore,
mechanical stress increases the output of NO by chondrocytes, as well as the
expression of nitric oxide synthase ( NOS), both by static compression as by
dynamics then cartilage becomes soft and lead to exposure of the bone of the joint
(3).
2) Bone : sclerosis of the bone and thickening with a smooth surface leads to small
fracture causing a gap allowing accumulation of synovial fluid in fibrous walled
cyst (3).
3) Synovium : inflammation occurs with congestion and fibrosis. Synovitis may be
subclinical, particularly in the early stages of OA. Arthroscopic studies show

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 synovia alterations in up to 50% of OA patients, many of whom had no clinical
synovitis signs.(3)

Complications(1) :

▪ Pain sensation
▪ Drops and falls
▪ Ambulatory problems
▪ Joint malaise
▪ Diminished range of joint motion
▪ Radicular disease

Diagnosis and investigation :

Osteoarthritis diagnosis will usually be performed clinically, and then checked by

radiography. In the absence of systemic features (such as fever), the key features that
indicate the diagnosis include discomfort, pain, stiffness, decreased mobility,
swelling, crepitus and increased age (unusual before age 40) . Physical examination
should have an assessment of body weight, range of joint movement, location of
tenderness, strength of the muscle and stability of the ligament. Osteoarthritis can
occur in any synovial joint in the body, but the hands, knees, and hips are most
common. Diagnosis typically includes evaluating the variety of clinical features to be
viewed, including imagery. As disease occurs, it is visible on simple x-rays showing a
narrowing of the joint area, osteophytes and often changes in the subchondral bone
(2). Among other soft tissue abnormalities, differential diagnosis should include
rheumatoid arthritis, psoriatic arthritis, crystalline arthritis, hemochromatosis, bursitis,
avascular necrosis, tendinitis, radiculopathy.

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Treatment :

The management goals are to (2):

▪ Inform patients about the illness and how to treat it

▪ To ward off pain

▪ Enhancing role

▪ To change the disease process and its outcome

The treatment should be according to patient’s response and clinician’s preference and
consider non-pharmacological management

as first line for all patients fig 3 (2)

Fig3:Stepwise algorithm for the management of patients with osteoarthritis

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Summary

Osteoarthritis is the most common type of arthritis that affects millions around the globe.
It happens when over time the protective cartilage which cushions the ends of your bones
wears down.

Even though osteoarthritis can damage any joint, your hands, knees, hips and spine are
most commonly affected by the disorder.

Symptoms of osteoarthritis can usually be managed although joint damage can not be
reversed. Staying active, maintaining a healthy weight and other medications may delay
the disease 's progression and help improve pain and joint function.

Osteoarthritis diagnosis is based on clinical presentation, which is accompanied by

radiography.

Effective non-pharmacological and pharmacological treatments for the management of

osteoarthritis are available; first, non-pharmacological treatments should be tried.

Surgical intervention should be taken into consideration when medical treatment fails

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References

(1)Sen R, Hurley JA. Osteoarthritis. [Updated 2020 Mar 30]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK482326/?report=classic

(2) Hunter, D. J., & Felson, D. T. (2006). Osteoarthritis. BMJ (Clinical research
ed.), 332(7542), 639–642. https://doi.org/10.1136/bmj.332.7542.639

(3) de Rezende MU, de Campos GC, Pailo AF. Current concepts in osteoarthritis. Acta
Ortop Bras. 2013;21(2):120‐122. Doi:10.1590/S1413-78522013000200010

(4) Chen, D., Shen, J., Zhao, W., Wang, T., Han, L., Hamilton, J. L., & Im, H. J. (2017).
Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone
research, 5, 16044. https://doi.org/10.1038/boneres.2016.44

(5) National Clinical Guideline Centre (UK). Osteoarthritis: Care and Management in
Adults. London: National Institute for Health and Care Excellence (UK); 2014 Feb.
(NICE Clinical Guidelines, No. 177.) 1, Introduction. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK333078/

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