OSTEOARTHRITIS

OSTEOARTHROSIS

DEGENERATIVE JOINT DISEASE

DEFINITION

Osteoarthritis OA is a degenerative disease of diarthrodial (synovial) joints, characterized by

Breakdown of articular cartilage

and proliferative changes of surrounding bones

EPIDEMIOLOGY

Osteoarthritis(OA) is the most common joint disease

OA of the knee joint is found in 70% of the population over 60 years of age

Radiological evidence of OA can be found in over 90 % of the population

LIMITED FUNCTION

OA may cause functional loss

Activites of daily living

Most important cause of disability in old age

Major indication for joint replacement surgery

CHARACTERISTICS OF OA

OA is a chronic disease of the musculoskeletal system, without systemic involvement

OA is mainly a noninflammatory disease of synovial joints

No joint ankylosis is observed in the course of the disease

CLASSIFICATION OF OA

Primary OA Secondary OA

Etiology is unknown Etiology is known

AGE

Primary OA > 40 years

Direct correlation

Aging process

RISK FACTORS FOR PRIMARY OA

Age

Sex

Obesity

Genetics

Trauma (daily)

SECONDARY OSTOARTHRITISTraumaPrevious joint disorders;Congenital hip dislocationInfection: Septic arthritis, Brucella, TbInflammatory: RA, ASMetabolic: GoutHematologic: HemophiliaEndocrine: DM

ETIOLOGY OF OA

Cartilage properties

Biomechanical problem

Morphology of Primary OA

LABORATORY FINDINGS OF OA

There are no pathognomonic laboratory findings for OA

Laboratory analysis is performed for differential diagnosis

RADIOLOGIC FINDINGS OF OA

Narrowing of joint space

(due to loss of cartilage)

Osteophytes

Subchondral (paraarticular) sclerosis

Bone cysts

RADIOLOGIC GRADE OF OA

G1 Normal

G2 Mild

G3 Moderate

G4 Severe

Kellgren Lawrence Classification

DIAGNOSIS OF OA

CLINICAL FINDINGS

Joint pain

+

RADIOLOGIC FINDINGS

Osteophytes

CLINIC OF OA SIGNS AND SYMPTOMS

Joint pain - degenerative

Stiffness following inactivity – 30 min

Limitation of ROM – later stages

Deformity – restricition of ADL

OA OF KNEE JOINT (GONARTHROSIS)

More common in obese females over 50 years of ageJoint stiffness (<30 minutes)Mechanical painPhysical examination findings: CrepitusPain on pressurePainful ROM and functional limitationLimitation of ROM in later stages of OA (first extension)Laboratory analysis within normal limits

OA OF HIP JOINT

More common in males over 40 years of age

Joint stiffness

Pain of hip, gluteal and groin areas radiating to the knee (N obturatorius)

Mechanical pain

Limited walking function

ETIOPATHOGENESIS OF OA

Age,gender

Local

Genetic OA biochemical effects

Other factors

TREATMENT OF OA

Symptomatic treatment

Structure modifying treatment

Surgical treatment

STRUCTURE MODIFYING TREATMENT

Hyaluronic acid injection (HA)

Glycose amino glycans (GAG)

PRIMARY PREVENTION OF OA ??

Regular exercises

Weight control

Prevention of trauma

AIMS OF OA TREATMENT

Pain relief

Preservation and restoration of joint function

Education

Non-Pharmacologic Treatment of OA

Patient educationWeight loss (if overweight)Aerobic exercise programsPhysical therapy Range-of-motion exercises Muscle-strengthening exercisesOccupational therapyJoint protection and energy conservation

PHARMACOLOGIC TREATMENT OF OA

Oral Systemic Medical Agents - Analgesics (acetaminophen) - NSAIDs - Opioid analgesics

Intraarticular agents: Hyaluronan Glucocorticoids (effusion)

Topical agents

HAND OA - RESTING SPLINT

SYMPTOMATIC TREATMENT OF OA

Decrease of joint loading

- Weight control

- Splinting

- Walking sticks

Exercises

- Swimming

- Walking

- Strengthening

Patient education

INDICATIONS OF SURGICAL INTERVENTION

Severe joint pain,

resistant to conservative treatment methods

Limitation of daily living activities

Deformity, angular deviations, instability

Cardiovascular Disease

Direct and indirect costs (in billions of dollars) of major cardiovascular diseases and stroke (United States: 2008)

Source: National Heart, Lung, and Blood Institute.

©2011 American Heart Association, Inc. All rights reserved. Roger VL et al. Published online in Circulation Dec. 15, 2011

Types Of Cardiovascular Disease

Atherosclerosis

Coronary heart disease (CHD)• Chest pain (angina pectoris)• Irregular heartbeat (arrhythmia)• Congestive heart failure (CHF)• Congenital and rheumatic heart disease• Stroke

Development of Atherosclerotic Plaques

NormalFatty streak

Foam cells

Lipid-rich plaque

Lipid core

Fibrous cap

Thrombus

Ross R. Nature. 1993;362:801-809.

(Adapted from Glagov et al.)(Adapted from Glagov et al.)

Coronary RemodelingCoronary Remodeling

NormalNormalvesselvessel

MinimalMinimalCADCAD

ProgressionProgression

Compensatory expansionCompensatory expansionmaintains constant lumenmaintains constant lumen

Expansion Expansion overcome:overcome:

lumen narrowslumen narrows

SevereSevereCADCAD

ModerateModerateCADCAD

Glagov et al, Glagov et al, N Engl J MedN Engl J Med, 1987., 1987.

Intraluminal thrombusGrowth of thrombus

Intraplaque thrombus Lipid pool

Blood Flow

Atherosclerotic Plaque Rupture and Thrombus Formation

Adapted from Weissberg PL. Eur Heart J Supplements 1999:1:T13–18

Mylifecheck.heart.org

                                                                                                           

                                                                                                  

         

                                                                                                           

                                                                                                  

         

                                                                                                           

                                                                                                  

         

                                                                                                           

                                                                                                  

         

Reducing Your Risk For Cardiovascular Diseases

• Risks you can control Avoid tobacco Cut back on saturated fat and cholesterol Maintain a healthy weight Modify dietary habits Exercise regularly Control diabetes Control blood pressure

Systolic – upper numberDiastolic – lower number

Manage stress

Reducing Your Risk For Cardiovascular Diseases

• Risks you cannot controlHeredityAgeGenderRace