Osteoartritis is the strongest risk factor. More common

Osteoartritis is a nonerosive,
ininflammatory progressive disorder of the joints leading to deterioration of
the articular cartilage and new bone formation at the joint surfaces and
margin.  It’s a disease of cartilage not
bone.  OA result from a complex interplay
of multiple factors, including joint intergrity, genetics, local inflammation,
mechanical forces and cellular and biochemical processes.

OA is the most common form of arthritis and
a common form of disability.  Prevalence
increase with age. Increase with repetitive trauma. More common in female >
60 years old

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Pathology

Early changes consist of hypercellularity
of chondrocytes.  Swelling and loosening
of the collagen framework leading to cartilage breakdown.  Increased proteoglycan synthesis.minimal
inflammation.

Later changes consisting of fissuring,
pitting and destruction. Hypocellularity of chondrocytes. Inflammation
secondary to synovitis. Osteophytes spur formation at the joint margin.  Subcondral bone sclerosis. Cysts formation in
the juxta articular bone

Risk factors:

Age and gender: advanced age is the
strongest risk factor.  More common in
males than females in age less than 50 and more common in female than males in
age more than 55 years old.  Female sex
is associated with increased risk of developing OA and once started experiences
rapid structural damage as compared to male.

Obeisity: 
obeisity is the most modifiable risk factor associated with the
development of OA

Lack of osteoporosis: higher bone mass is
associated with an increase risk of hip OA in older females

Occupation: studies shows that knee OA are
more associated with repetitive knee bending work.  Hand and hip OA are associated with physical
labour

Sport activities:  Sports activities associated with increased
risk of OA include wrestling, boxing, base ball pitching, cycling, recreational
parachuting, cricket, gymnastics, ballet dancing, soccer, football

Previous injury

Muscle weakness

Proprioceptive deficit

Genetics

Acromegaly

Calcium deposition disease

 

Classification

Primary

Secondary OA

Erosive inflammatory OA

DISH

 

Sign and symptoms

Symptoms: 
joint pain increased with activity and relieved by rest.  Joint stiffness for less than 30 mins and
becomes worse as the day goes by.  Joint
giving way. Crepitus with movement

 

Sign:

Mono or pauciarticular

Localized tenderness of the joints. Pain
and crepitus of involved joints

Enlargement of the joint due to
proliferation of synovial fluid

Hebeden nodes due to osteophytosis  at the DIP joints and Bouchards nodes involve
PIP.  First CMC joint.  Hip and knee involvement. First mtp

Spondylosis of the spine

 

Radiographic finding

 

Asymmetric 
narrowing of the joint space. 
Knee result in medial joint space narrowing . hip results in superior
lateral joint space narrowing. Subchondral bony sclerosis new bone formation.

Osteophyte formation

Loose bodies

 

Treatment

Patient education: weight loss and activity
modification

 

Physical therapy and occupational therapy

ROM and strengthening exercises

Assistive device

Joint protection and energy conservation

 

Pharmacotherapy

 

Intra articular injections

Intraarticular injection may be beneficial
in acute attack

surgical