OsteoarthritisOsteoarthritis

ObjectivesObjectives

Compare & contrast the sequence of Compare & contrast the sequence of events leading to joint destruction in events leading to joint destruction in osteo-arthritis & rheumatoid arthritisosteo-arthritis & rheumatoid arthritis

Describe the clinical manifestations of Describe the clinical manifestations of OA and RAOA and RA

Compare & contrast the sequence of Compare & contrast the sequence of events leading to joint destruction in events leading to joint destruction in osteo-arthritis & rheumatoid arthritisosteo-arthritis & rheumatoid arthritis

Describe the clinical manifestations of Describe the clinical manifestations of OA and RAOA and RA

OsteoarthritisOsteoarthritis

Most common form of joint disease in Most common form of joint disease in NZNZ

Non-inflammatory disorder of the Non-inflammatory disorder of the synovial jointssynovial joints

Slowly progressive Slowly progressive More than 90% of adults are affected More than 90% of adults are affected

by age 40by age 40

Most common form of joint disease in Most common form of joint disease in NZNZ

Non-inflammatory disorder of the Non-inflammatory disorder of the synovial jointssynovial joints

Slowly progressive Slowly progressive More than 90% of adults are affected More than 90% of adults are affected

by age 40by age 40

OsteoarthritisOsteoarthritis

Before age 50, men are more often Before age 50, men are more often affected than womenaffected than women

Incidence of OA after 50 is twice as Incidence of OA after 50 is twice as great in womengreat in women

Before age 50, men are more often Before age 50, men are more often affected than womenaffected than women

Incidence of OA after 50 is twice as Incidence of OA after 50 is twice as great in womengreat in women

Etiology and PathophysiologyEtiology and Pathophysiology

Cause can be unknown or a known Cause can be unknown or a known event or condition that directly event or condition that directly damages cartilage or causes joint damages cartilage or causes joint instability e.g.. trauma, repetitive instability e.g.. trauma, repetitive physical activities, congenital physical activities, congenital dislocation of the hipdislocation of the hip

Cause can be unknown or a known Cause can be unknown or a known event or condition that directly event or condition that directly damages cartilage or causes joint damages cartilage or causes joint instability e.g.. trauma, repetitive instability e.g.. trauma, repetitive physical activities, congenital physical activities, congenital dislocation of the hipdislocation of the hip

Etiology and PathophysiologyEtiology and Pathophysiology

Estrogen reduction at menopauseEstrogen reduction at menopauseGenetic factorsGenetic factorsObesityObesityStrenuous exercise activitiesStrenuous exercise activities

Estrogen reduction at menopauseEstrogen reduction at menopauseGenetic factorsGenetic factorsObesityObesityStrenuous exercise activitiesStrenuous exercise activities

Etiology and PathophysiologyEtiology and Pathophysiology

Results from cartilage damageResults from cartilage damageCauses the normally smooth, white, Causes the normally smooth, white,

translucent articular cartilage to translucent articular cartilage to become dull, yellow & granularbecome dull, yellow & granular

Affected cartilage:Affected cartilage:– Dull, yellow, granular– Softer, less elastic– Less able to resist wear

Results from cartilage damageResults from cartilage damageCauses the normally smooth, white, Causes the normally smooth, white,

translucent articular cartilage to translucent articular cartilage to become dull, yellow & granularbecome dull, yellow & granular

Affected cartilage:Affected cartilage:– Dull, yellow, granular– Softer, less elastic– Less able to resist wear

Etiology and PathophysiologyEtiology and Pathophysiology

Body’s attempts at repair cannot keep Body’s attempts at repair cannot keep up with destructionup with destruction

Continued changes in collagen Continued changes in collagen structure structure fissuring and erosion fissuring and erosion

Body’s attempts at repair cannot keep Body’s attempts at repair cannot keep up with destructionup with destruction

Continued changes in collagen Continued changes in collagen structure structure fissuring and erosion fissuring and erosion

Etiology and PathophysiologyEtiology and Pathophysiology

Central cartilage becomes thinnerCentral cartilage becomes thinnerCartilage and bony growth Cartilage and bony growth

(osteophytes) increase at the joint (osteophytes) increase at the joint marginsmargins

Secondary synovitisSecondary synovitis

– Inflammatory changes early pain and stiffness

Central cartilage becomes thinnerCentral cartilage becomes thinnerCartilage and bony growth Cartilage and bony growth

(osteophytes) increase at the joint (osteophytes) increase at the joint marginsmargins

Secondary synovitisSecondary synovitis

– Inflammatory changes early pain and stiffness

Pathophysiology of osteoarthritisPathophysiology of osteoarthritis

Clinical ManifestationsClinical Manifestations

No systemic manifestationsNo systemic manifestationsJoint painJoint pain

– Predominant symptom

– Relieved by rest in early stages

No systemic manifestationsNo systemic manifestationsJoint painJoint pain

– Predominant symptom

– Relieved by rest in early stages

Clinical ManifestationsClinical Manifestations

Joint painJoint pain

– Generally worsens with joint use

– May become worse as barometric pressures fall before inclement weather

Joint painJoint pain

– Generally worsens with joint use

– May become worse as barometric pressures fall before inclement weather

Clinical ManifestationsClinical Manifestations

Joint painJoint pain

– May be referred to:

• Groin

• Buttock

• Medial side of thigh or knee

Joint painJoint pain

– May be referred to:

• Groin

• Buttock

• Medial side of thigh or knee

Clinical ManifestationsClinical Manifestations

Joint painJoint pain

– Crepitation

• Grating sensation caused by loose particles of cartilage in the joint cavity

Joint painJoint pain

– Crepitation

• Grating sensation caused by loose particles of cartilage in the joint cavity

Clinical ManifestationsClinical Manifestations

Joint pain

– Affects joints asymmetrically

– Early morning stiffness

• Resolves within 30 minutes

Joint pain

– Affects joints asymmetrically

– Early morning stiffness

• Resolves within 30 minutes

Clinical ManifestationsClinical Manifestations

Most commonly involved joints:Most commonly involved joints:– Distal interphalangeal (DIP)– Proximal interphalangeal (PIP)– Carpometacarpal joint of the thumb– Weight-bearing joints (hips, knees)– Metatarsophalangeal (MTP)– Cervical and lower lumbar vertebrae

Most commonly involved joints:Most commonly involved joints:– Distal interphalangeal (DIP)– Proximal interphalangeal (PIP)– Carpometacarpal joint of the thumb– Weight-bearing joints (hips, knees)– Metatarsophalangeal (MTP)– Cervical and lower lumbar vertebrae

Joints Involved in OsteoarthritisJoints Involved in OsteoarthritisJoints Involved in OsteoarthritisJoints Involved in Osteoarthritis

Fig. 63-2

Clinical Manifestations - DeformityClinical Manifestations - Deformity

Specific to involved jointSpecific to involved joint– Heberden’s & Bouchard’s nodes

• Indication of osteophyte formation & loss of joint space

• Appear from age 40 & tend to be seen in families

• Often red, swollen & tender• Do not cause significant loss of

function

Specific to involved jointSpecific to involved joint– Heberden’s & Bouchard’s nodes

• Indication of osteophyte formation & loss of joint space

• Appear from age 40 & tend to be seen in families

• Often red, swollen & tender• Do not cause significant loss of

function

Hand Deformormities - NodesHand Deformormities - Nodes

Osteoarthritis HandsOsteoarthritis Hands

Clinical ManifestationsClinical Manifestations

DeformityDeformity

– Bouchard’s nodes

• PIP joints

– Nodes often red, swollen, tender

DeformityDeformity

– Bouchard’s nodes

• PIP joints

– Nodes often red, swollen, tender