Certainly!

Degenerative joint disease, also known as osteoarthritis (OA), is a common

condition that affects the joints, leading to pain and functional impairment. Based on
information typically found in "Davidson's Principles and Practice of Medicine,"
here's a detailed description of the etiopathogenesis, clinical presentation,
identification, functional changes, acute care, stabilization, management, and
rehabilitation of degenerative joint disease:

Etiopathogenesis

Etiology:

 Primary OA: Idiopathic; commonly associated with aging and no identifiable cause.
 Secondary OA: Results from predisposing factors such as joint trauma, congenital joint
abnormalities, metabolic diseases (e.g., hemochromatosis), or inflammatory joint diseases
(e.g., rheumatoid arthritis).

Pathogenesis:

 Cartilage Degradation: Breakdown of articular cartilage due to imbalance between anabolic

and catabolic processes in chondrocytes.
 Inflammation: Low-grade inflammation within the joint, with release of cytokines and
enzymes that further degrade cartilage.
 Bone Changes: Subchondral bone sclerosis, formation of osteophytes (bone spurs), and bone
cysts.
 Synovial Changes: Synovial inflammation and hyperplasia.

Clinical Presentation

Symptoms:

 Pain: Gradual onset, worsened by activity, relieved by rest. Commonly affects weight-bearing
joints (e.g., knees, hips), hands, and spine.
 Stiffness: Typically occurs after periods of inactivity, often referred to as "gelling" and usually
lasts less than 30 minutes.
 Swelling: Mild joint effusion and periarticular soft tissue swelling.
 Decreased Range of Motion: Due to pain, joint effusion, and structural changes.
 Crepitus: Grinding sensation during joint movement.

Signs:

 Joint Deformity: Bony enlargements such as Heberden’s nodes (distal interphalangeal joints)
and Bouchard’s nodes (proximal interphalangeal joints).
 Tenderness: On palpation of the affected joints.
 Muscle Weakness: Around the affected joints due to disuse atrophy and pain.

Identification

Diagnostic Criteria:

 Clinical Assessment: Based on history and physical examination.

 Radiographic Features:
 o Joint space narrowing
o Osteophyte formation
o Subchondral sclerosis
o Subchondral cysts

Additional Tests:

 MRI: More sensitive in detecting early cartilage changes, subchondral bone changes, and soft
tissue involvement.
 Laboratory Tests: Generally normal in primary OA but may be used to rule out other
conditions (e.g., rheumatoid arthritis).

Functional Changes
 Decreased Mobility: Limited joint movement affects daily activities.
 Reduced Strength: Muscle weakness around the affected joints.
 Altered Biomechanics: Changes in gait and posture to compensate for pain and stiffness.
 Impact on Quality of Life: Chronic pain and disability lead to reduced physical activity and
social participation.

Acute Care

Pain Management:

 NSAIDs: First-line for pain relief and anti-inflammatory effects.

 Acetaminophen: For mild to moderate pain.
 Opioids: For severe pain, with caution due to addiction potential.
 Topical Agents: Capsaicin, NSAID creams.

Joint Protection:

 Rest: Short periods to reduce pain and inflammation.

 Assistive Devices: Braces, orthotics, and walking aids to reduce joint load.

Stabilization

Non-Pharmacological Interventions:

 Weight Management: To reduce stress on weight-bearing joints.

 Physical Therapy: Exercises to improve strength, flexibility, and range of motion.
 Occupational Therapy: Adaptive strategies for daily activities.
 Patient Education: Information on disease process, self-management, and lifestyle
modifications.

Management

Long-Term Pharmacological Treatment:

 NSAIDs: Regular use, monitoring for side effects.

 Intra-Articular Injections: Corticosteroids for acute flare-ups; hyaluronic acid for lubrication
and pain relief.
 Supplements: Glucosamine and chondroitin, though evidence is variable.
Surgical Interventions:

 Arthroscopy: For debridement in selected cases.

 Osteotomy: Realignment surgery to redistribute load.
 Joint Replacement: Total joint arthroplasty in severe cases with significant pain and
disability.

Rehabilitation

Goals:

 Restore Function: Improve joint function and overall mobility.

 Alleviate Pain: Through various therapeutic modalities.
 Enhance Quality of Life: Enable patients to engage in daily and recreational activities.

Rehabilitation Strategies:

 Exercise Programs: Tailored to individual needs; includes strength training, aerobic exercises,
and flexibility exercises.
 Hydrotherapy: Aquatic exercises to reduce joint stress.
 Pain Management Techniques: TENS (Transcutaneous Electrical Nerve Stimulation),
acupuncture.
 Psychological Support: Counseling and support groups for coping with chronic disease.