OSTEOARTHRITIS

OSTEOARTHRITIS

• DEFINITION  DEGRADATION AND LOSS OF ARTICULAR

CARTILAGE ACCOMPANIED BY SUBCHONDRAL BONE
REMODELLING, OSTEOPHYTES FORMATION, AND SYNOVITIS
• MOST COMMON MUSCULOSKELETAL PROGRESSIVE DISEASE,
TYPICALLY AFFECTS PEOPLE OVER THE AGE OF 50
• CHARACTERISTICALLY THE MAJOR COMPONENT OF THE
CLINICAL PRESENTATION IS PAIN AND DECREASED FUNCTION
> 75% OF PEOPLE OVER THE AGE OF 75 HAVE X-RAY EVIDENCE
OF DISEASE
> 75% OF PEOPLE OVER THE AGE OF 85 ARE SYMPTOMATIC
 EPIDEMIOLOGY

• APPROXIMATELY 250 MILLION PEOPLE WORLDWIDE SUFFER FROM

OSTEOARTHRITIS
• ACCORDING TO GLOBAL BURDEN OF DISEASES, INJURIES, AND
RISK FACTORS STUDY 2015 BY DISEASE AND INJURY INCIDENCE
AND PREVALENCE COLLABORATORS, APPROXIMATELY 85% OF THE
BURDEN OF OA WORLDWIDE IS CONNECTED WITH KNEE OA, WITH
AN ESTIMATED PREVALENCE OF 10% IN MEN AND 13% IN WOMEN
AGED 60 AND ABOVE
RISK FACTOR

NON-MODIFIABLE MODIFIABLE
• AGE • MAJOR TRAUMA

• RACE • REPETITIVE STRESS

• GENETICS (COL 2A1 GENE) • INFLAMMATORY JOINT

DISEASE
• FEMALE SEX
• OBESITY
• METABOLIC AND ENDOCRINE
• SMOKING
DISEASE
• CONGENITAL DEFECT • HORMONE

• NEUROLOGICAL DEFECT • QUADRICEPS MUSCLE

WEAKNESS

• Hochberg MC. J Rheumatol 1991; 18: 1438-40.

ETIOPATHOGENESIS

• NORMAL CARTILAGE AND SUPPORTING

STRUCTURES SUBJECTED TO ABNORMALLY
INCREASED LOADS
• OBESITY
• OVERUSE SYNDROMES

• ABNORMAL CARTILAGE AND SUPPORTING

STRUCTURES SUBJECTED TO EITHER MINIMAL
LOADS OR ABNORMALLY LARGE LOADS
• INHERITED DEFECTS OF STRUCTURAL COMPONENTS (E.G. TYPE II
COLLAGEN, CARTILAGE LYSIS SYNDROME, HYPERMOBILE SYNDROMES)
• OCHRONOSIS
 DIAGNOSIS
SYMPTOMS
• PAIN
• DECREASED FUNCTION
• DUE TO BONEY CHANGE
• DUE TO SOFT-TISSUE CHANGE OR SWELLING
• DUE TO ALTERATION OF THE NORMAL STRUCTURES
• CREPITANCE OR “CRUNCHING WITHIN THE JOINT”

SIGNS
• ASYMMETRY OF FINDINGS USUALLY OF LARGE JOINTS
• HEBERDENS/BOUCHARD’S NODES (MAY BE SYMMETRICAL)
• CLASSIC HAND INVOLVEMENT: DIP/PIP NODULAR DISEASE
• SOME BONEY SWELLING
• SOME SWELLING AND PAIN OUT OF PROPORTION TO
INFLAMMATORY FINDINGS
RADIOGRAPHIC FEATURES
CARDINAL SIGNS

• JOINT SPACE NARROWING

• MARGINAL
OSTEOPHYTES
• SUBCHONDRAL CYSTS
• BONEY SCLEROSIS
• MALALIGNMENT
 MANAGEMENT
NON-PHARMACOLOGY

• PATIENTS EDUCATION, SELF-MANAGEMENT

PROGRAM
• WEIGHT CONTROL
• PHYSICAL THERAPY, OCCUPATIONAL
THERAPY
• EXERCISE PROGRAM
• ASSISTIVE DEVICES
• JOINT PROTECTION
• APPROPRIATE FOOT WARE
Modified from ACR subcommittee. A&R 2000; 43:1905-15.
 MANAGEMENT
ORAL AND TOPICAL PHARMACOLOGICAL GUIDELINES
Opioid Analgesics
Guideline
Year of Issue Acetaminophen Peroral NSAIDs SYSADOA Topical NSAIDs
Author Tramadol Other
Unable to give Strong Positive
Positive Positive
AAOS 2013 any recommendation
Inconclusive recommendation recommendatio
recommendation
recommendation against use n
Strong
Conditional Conditional Conditional Recommended Strong
recommendatio
ACR/AF 2020 recommendation recommendation recommendation as first-line recommendation
n for use prior
for for against treatment against use
to oral NSAIDs
Conditional Recommended Recommended
OARSI 2019 recommendation Strong recommendation against as first-line Not included as first-line
against treatment treatment
Weak
recommendation
against as single Recommended Recommended
therapy, should Recommended as first-line, in addition to
be used as Conditional recommendation for as as first-line, long-term SYSADOA and
ESCEO 2019
rescue medicine third-line treatment short-term treatment for acetaminophen
in addition to treatment pharmaceutical- prior to oral
first-line grade products NSAIDs
treatment with
SYSADOA

AAOS—American Academy of Orthopedic Surgeons;

ACR/AF—American College of Rheumatology/Arthritis Foundation;
OARSI—Osteoarthritis Research Society International;
ESCEO—European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases;
NSAIDs—nonsteroidal anti-inflammatory drugs;
SYSADOA—systemic slow-acting drugs in osteoarthritis.
 MANAGEMENT
INTRAARTICULAR PHARMACOLOGICAL GUIDELINES
Guideline Author Year of Issue IACS IAHA PRP MSCs
Unable to give any Unable to give any
AAOS 2013 Not recommended Not included
recommendation recommendation
Strong Strong
recommendation recommendation
against, against
Strong Conditional
(heterogeneous (heterogeneous
ACR/AF 2020 recommendation for recommendation
studies, lack of studies, lack of
short-term analgesia against
preparation and preparation and
application application
standardization) standardization)
Strong Strong
Conditional
recommendation recommendation
Conditional recommendation for a
against (non- against (non-
OARSI 2019 recommendation for long-term effect where
standardized standardized
short-term analgesia multiple IACS are
formulations, low- formulations, low-
contraindicated
quality evidence) quality evidence)
Weak recommendation
Weak recommendation
for short-term
for, only to be used
analgesia when
when patients have a
patients have a
ESCEO 2019 contraindication for the Not included Not included
contraindication for the
use of NSAIDs or have
use of NSAIDs or have
insufficient analgesia
insufficient analgesia
on NSAID therapy
on NSAID therapy

AAOS—American Academy of Orthopedic Surgeons; ACR/AF—American College of Rheumatology/Arthritis Foundation; OARSI—Osteoarthritis

Research Society International; ESCEO—European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal
Diseases;

IACS—intra-articular corticosteroids; IAHA—intra-articular hyaluronic acid; PRP—platelet-rich plasma; MSCs—mesenchymal stem cells; NSAIDs—
nonsteroidal anti-inflammatory drugs.
 SURGICAL MANAGEMENT

• ARTHROSCOPIC PROCEDURES
• DECOMPRESSIVE PROCEDURES
• ARTHRODESIS
• OSTEOTOMY
• JOINT REPLACEMENT
 POST OPERATIVE MANAGEMENT

• PATIENTS SURGICALLY TREATED FOR OA OFTEN

SUFFER FROM PAIN AND HAVE PROBLEMS IN
CARRYING OUT DAILY ACTIVITIES, AND
PHYSICAL ACTIVITY PROGRAMS COULD
ATTENUATE THESE DEFICITS
• STRENGTHENING EXERCISES, AEROBIC
EXERCISES, OR BOTH TOGETHER, SHOW
POSITIVE EFFECTS IN REDUCING PAIN AND
IMPROVING PHYSICAL FUNCTION