Download PDF

Osteoarthritis  – Degenerative joint disease (DJD). No inflammation. Destruction of articular cartilage and surrounding joint structures. The most common symptoms are joint pain and stiffness. Asymmetric, mono / oligo articular involvement.

Common joints being affectedjoints-affected-by-osteo-arthritis

  • Cervical
  • lumbosacral spine
  • hip
  • knee
  • 1st MTP
  • DIP – (Heberden nodes) — Osteophytes —> Joint enlargement
  • PIP – (Boucahrd nodes)
  • 1st CMC (base of thumb – squaring)

*Proximal = Letter “B”; Distal = Letter  “H”

Classification

  1. Primary (idiopathic)

  2. Secondary

  • Other arthropathy (gout)
  • Endocrine (Agromegaly, DM)
  • Post traumatic
  • Mechanical factors (varus or valgus deformity, mechanical factors)

Risk Factors

  • Age
  • Female sex
  • Genetic predisposition
  • major joint trauma
  • obesity
  • stress
  • repetitive use of joints (e.g. Farmers –> Hip joint)

Signs and symptoms

  • pain
  • short duration of morning stiffness (< 30 minutes)
  • fatigue
  • poor sleep
  • joint pain increase with movement; relieved by rest
  • joint crepitation on passive range of motion

Lab Test and investigations

  • normal CBC, ESR, CRP
  • ANA and RF (-)ve

Radiology

  1. Joint space narrowing
  2. Osteophytes
  3. Dense subchondral bones
  4. subchondral cyst

Treatment

The goal of treatment is minimize pain and increase the quality of life. Presently no treatment completely cure the disease.

non-pharmacotherapy

  • Avoiding activities that overload the joints
  • moderate exercise: improve the strength of the muscle that connected to the joints (physiotherapy)
  • weight loss

pharmacotherapy

  • Acetaminophen, NSAID, COX-2 inhibitor (celexicob) *not for long term treatment
  • Intra articular injections: corticosteroid, hyaluronic acid (Hyaluronan)
  • Topical: NSAID (Diclofenac), Capasaicin cream

surgical treatment

  • Joint replacement
  • osteotomy

Herbeden nodes in Osteo arthritis

Herbeden nodes in Osteo arthritis



Mnemonic
L: loss of joint space
O: osteophytes
S: subchondral cysts
S: subchondral sclerosis

Download as Word document

Download PDF