Osteoarthritis
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Osteoarthritis Definition: It is a disease of synovial joint characterized by articular cartilage loss with an accompanying periarticular bone response. Note it’s the most common form of arthritis.
Epidemiology: •
World wide.
•
Its twice as common in females as in males.
•
There is marked familial tendency (35-65% from multiple genes).
•
Primary OA uncommon before the age of 50 years.
Etiology: • Primary Unknown but affect elderly (more then 50 year old) and obese. • Secondary when degenerative joint change occur in response to a recognizable local or systemic factor.
Causes of secondary OA: •
Hip dysplasia.
•
RA.
•
SLE.
•
SCA.
•
Gout.
•
Paget's disease.
•
Goucher's disease.
•
Wilson's disease.
•
DM.
•
Tebes dorsalis.
•
Syringomyelia.
•
Peripheral nerve lesions.
1
Dr. julianajulie
•
Intra-articular fracture.
•
Occuoational.
•
Ehlers-Danlos syndrome.
•
Mesicectomy.
•
Hemophilia.
•
Alkatonuria.
•
Hemochrmatosis.
•
Chondrocalcinosis.
•
Acromegaly.
Pathology and Pathogenesis: Different insult can start the degenerative process but the most obvious: •
Mechanical insult trauma.
•
Biochemical abnormalities chondrocytes release enzymes that degrade collagen and protoglycan.
Progressive distruction and loss of articular cartilage exposed subchondral bone become sclerotic ↑ vascularity + cyst formation. Repair process produce cartilaginous growth at the margins of the joint clacified osteophtes.
Clinical Features: •
Pian wores with motion and relieved by rest.
•
Stiffness after rest, there is transient morning stiffness for less then 30 minutes.
•
Joints involved distal interphalangeal joint, first carpometacarpal joint of the hand, first metatarsophalangeal joint of the foot, weight bearing joints, vertebra, hip and knee.
Note elbow, wrist and ankle joint rarely affected. On Examination: •
Deformity.
•
Bony enlargement.
2
Dr. julianajulie
•
Limited joint movement.
•
Crepitus common finding due to disruption of normal smooth articulating surfaces of the joint effusion maybe present.
•
Muscle wasting.
•
Heberden's nodes swelling at DIPJ.
•
Bouchard's nodes swelling at PIPJ.
Note type of swelling is hard swelling due to osteophtes formation. •
In knee, cartilage loss due to OA results in Varus or Valgus angulation.
•
Fluctuant swelling along posterior aspect of the knee, popliteal or Baker's cyst occur in some patients with knee effusion.
Note Asymmetrical joint involvement.
Differential Diagnosis: •
RA.
•
Pyrophosphate arthropathy.
•
Chronic tophaceous Gout.
•
Psoriatic arthritis.
Investigations: •
CBC and ESR Normal.
•
X-ray only abnormal in advanced disease, shows narrowing of the joint space (due to loss of cartilage), ostoephytes, subchondral sclerosis and cyst formation.
3
Dr. julianajulie
Epidemiology: •
World wide.
•
Its twice as common in females as in males.
•
There is marked familial tendency (35-65% from multiple genes).
•
Primary OA uncommon before the age of 50 years.
Etiology: • Primary Unknown but affect elderly (more then 50 year old) and obese. • Secondary when degenerative joint change occur in response to a recognizable local or systemic factor.
Causes of secondary OA: •
Hip dysplasia.
•
RA.
•
SLE.
•
SCA.
•
Gout.
•
Paget's disease.
•
Goucher's disease.
•
Wilson's disease.
•
DM.
•
Tebes dorsalis.
•
Syringomyelia.
•
Peripheral nerve lesions.
1
Dr. julianajulie
•
Intra-articular fracture.
•
Occuoational.
•
Ehlers-Danlos syndrome.
•
Mesicectomy.
•
Hemophilia.
•
Alkatonuria.
•
Hemochrmatosis.
•
Chondrocalcinosis.
•
Acromegaly.
Pathology and Pathogenesis: Different insult can start the degenerative process but the most obvious: •
Mechanical insult trauma.
•
Biochemical abnormalities chondrocytes release enzymes that degrade collagen and protoglycan.
Progressive distruction and loss of articular cartilage exposed subchondral bone become sclerotic ↑ vascularity + cyst formation. Repair process produce cartilaginous growth at the margins of the joint clacified osteophtes.
Clinical Features: •
Pian wores with motion and relieved by rest.
•
Stiffness after rest, there is transient morning stiffness for less then 30 minutes.
•
Joints involved distal interphalangeal joint, first carpometacarpal joint of the hand, first metatarsophalangeal joint of the foot, weight bearing joints, vertebra, hip and knee.
Note elbow, wrist and ankle joint rarely affected. On Examination: •
Deformity.
•
Bony enlargement.
2
Dr. julianajulie
•
Limited joint movement.
•
Crepitus common finding due to disruption of normal smooth articulating surfaces of the joint effusion maybe present.
•
Muscle wasting.
•
Heberden's nodes swelling at DIPJ.
•
Bouchard's nodes swelling at PIPJ.
Note type of swelling is hard swelling due to osteophtes formation. •
In knee, cartilage loss due to OA results in Varus or Valgus angulation.
•
Fluctuant swelling along posterior aspect of the knee, popliteal or Baker's cyst occur in some patients with knee effusion.
Note Asymmetrical joint involvement.
Differential Diagnosis: •
RA.
•
Pyrophosphate arthropathy.
•
Chronic tophaceous Gout.
•
Psoriatic arthritis.
Investigations: •
CBC and ESR Normal.
•
X-ray only abnormal in advanced disease, shows narrowing of the joint space (due to loss of cartilage), ostoephytes, subchondral sclerosis and cyst formation.
3
Dr. julianajulie
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