Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Osteoarthritis – DR DEACPIMP Definition Damage to articular cartilage and bone, causing pain and stiffness. Is generally associated with ageing and overuse. Risk factors Age >55 Obesity Physical occupation Previous joint damage, eg fracture Family history Differential diagnosis Bursitis Gout Psoriatic arthritis Rheumatoid arthritis Osteoporosis Musculoskeletal injury Fracture Cancer Epidemiology Strongly associated with age: 33% 45-65, 49% over 75, even higher proportion have radiological changes without symptoms Affects women more than men, 3:2 More common in Caucasian and Native American than Black WHO: one of the top 10 leading causes of disability Aetiology Previously thought to be simply ‘wear and tear’, but this is now thought to be overly simple A result of imbalance between stress and capacity/strength – load exceeds critical stress force Some genetic predisposing factors Clinical features Generally only one joint at a time – asymmetrical Affects larger joints eg: o Hip o Knee o Spine o DIP Cool joints, minimal swelling Tender and achey joints Morning stiffness <30 mins Exacerbated by use/exercise, relieved by rest Crepitus Pathophysiology Degradation of cartilage: increased water, decreased proteoglycans decreased elasticity Chondrocyte death, remaining chondrocytes multiply: ‘cloning’, which results in islands of aggregated chondrocytes Proteases break down cartilage and matrix Increased catabolic cytokines, eg IL-1, decreased anabolic cytokines eg IGF-1 Fibrillation: cracks appear in cartilage, allow synovial fluid in to bone – cause secondary synovitis, and vascularisation Osteoblast activation causes osteophytes and subchondral ossification Eburnation (bone becomes smooth from bone-on-bone grinding) Bone cysts are a result of synovial fluid entering the bone Investigations X-ray o Joint space narrowing o Subchondral sclerosis o Bone cysts o Osteophytes CRP and ESR to rule out inflammatory cause Management Local analgesics are first line: o Topical NSAIDS o Capsaicin (chili cream) Paracetamol added if necessary Interarticular corticosteroid injections – often give pain relief last weeks to months Oral NSAIDS and opioids if necessary Surgical: o Joint replacement Physical therapy Lifestyle advice: o Healthy diet o Exercise o No smoking Prognosis Doesn’t significantly affect life expectancy, although osteoarthritis tends to be progressive, and progressively disabling. More joints may become affected