1 IN THE NAME OF GOD. 2 OSTEOARTHRITIS 3 EPIDEMIOLOGY.

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IN THE NAME OF GOD

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OSTEOARTHRITISOSTEOARTHRITIS

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EPIDEMIOLOGYEPIDEMIOLOGY

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Most common type of arthritisMost common type of arthritis

A leading cause of disability in elderlyA leading cause of disability in elderly

Prevalence:Prevalence:

-- Aging Aging

-- Obesity Obesity

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Common in:Common in:Knee, hand, spine…Knee, hand, spine…

Spared:Spared:Wrist, elbow, shoulder, ankleWrist, elbow, shoulder, ankle

Symptomatic knee OA:Symptomatic knee OA:>30y 6%>30y 6%

>60y 12%>60y 12%

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Symptomatic hand OA:Symptomatic hand OA:10% of elderly10% of elderlyHand OA >50% of person >70yHand OA >50% of person >70y

Correlate strikingly with age:Correlate strikingly with age: -- <40y Uncommon <40y Uncommon

Sex:Sex:More common in womenMore common in women Sex differences with ageSex differences with age

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JOINT PROTECTORSJOINT PROTECTORS

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PROTECTORSPROTECTORS

Capsule and ligaments:Capsule and ligaments:Limits excursion Limits excursion

Muscles and tendons:Muscles and tendons:Key protectorKey protector

Function:Function:

- - Appropriate powerAppropriate power

-- Focal stress by: Focal stress by:

-- Decelerate joint Decelerate joint

-- Distribute across joint surface Distribute across joint surface

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Mechanoreceptor:Mechanoreceptor:In ligament, skin and tendonIn ligament, skin and tendon

Assume appropriate tensionAssume appropriate tension

Synovial fluid:Synovial fluid: FrictionFriction

Lubricin: secreted by fibroblasts Lubricin: secreted by fibroblasts Subchondral boneSubchondral bone

Shock-absorber Shock-absorber

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Cartilage:Cartilage:A thin rim of tissueA thin rim of tissue

Function:Function:

-- Frictionless surface Frictionless surface

-- Absorbing capacity Absorbing capacity

Component:Component:

-- Chondrocyte Chondrocyte

- - MatrixMatrix

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Chondrocyte:Chondrocyte:Synthesize all element of matrixSynthesize all element of matrix

Secret:Secret:

- - Growth factorsGrowth factors

- - Cytokines (MMP…)Cytokines (MMP…)

Matrix:Matrix:Type 2 collagen Tensile strengthType 2 collagen Tensile strength

Proteoglycans (aggrecan) Compressive strengthProteoglycans (aggrecan) Compressive strength

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PATHOPHYSIOLOGYPATHOPHYSIOLOGY

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Joint failureJoint failure

Initial step: failure of protective mechanismsInitial step: failure of protective mechanisms

Pathologic change in all structures of jointPathologic change in all structures of joint

Hallmark: hyaline cartilage lossHallmark: hyaline cartilage loss

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Chondrocytes:Chondrocytes: Metabolic activity, catabolic activity PGMetabolic activity, catabolic activity PG

Apoptosis Apoptosis

Chondrocytes and synovium:Chondrocytes and synovium:IL1IL1 and TNFaand TNFa

Chondrocyte

PROTEINASE

MATRIX SYNTHESIS

PG E2

NOPROTEINASE ACTIVITY

AGGRECAN SYNTHESIS

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OA cartilageOA cartilage

Aggrecan and CollagenAggrecan and Collagen

Compressive and Tensile strengthCompressive and Tensile strength

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RISK FACTORSRISK FACTORS

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AGE:AGE:Most potent Most potent Mechanisms:Mechanisms:

Matrix synthesis Thin cartilageMatrix synthesis Thin cartilage

Muscles:Muscles: -- Weaker Weaker - - Less quickly response Less quickly response

Slow sensory imputeSlow sensory impute

Ligament Ligament

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FEMALE FEMALE

GENETIC (OA in member):GENETIC (OA in member):Hand & Hip 50%Hand & Hip 50%

Knee 30%Knee 30%

Generalized Rare Generalized Rare

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JOINT:JOINT:

Developmental Developmental

FractureFracture

AVN (Avascular necrosis) AVN (Avascular necrosis)

Tear of ligamentTear of ligament

Menisc Menisc

Malalignment Malalignment

Bone densityBone density

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OBESITY:OBESITY:Knee in stance 3-6 times of weightKnee in stance 3-6 times of weight

Knee OA and less for hip and hand OAKnee OA and less for hip and hand OA

Women: Stronger (linear)Women: Stronger (linear)

SymptomSymptom

Mechanisms: Mechanisms: -- Loading Loading

-- Metabolic Metabolic

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REPEATED USE:REPEATED USE:Farmers: Hip Farmers: Hip

Miners: Knee and Spine Miners: Knee and Spine

Shipyards: Knee and FingerShipyards: Knee and Finger

Runners: HipRunners: Hip

Elite runner: Hip and Knee Elite runner: Hip and Knee

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PATHOLOGYPATHOLOGY

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PATHOLOGYPATHOLOGY

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PATHOLOGYPATHOLOGY

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PATHOLOGYPATHOLOGY

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PATHOLOGYPATHOLOGY

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SOURSE OF PAINSOURSE OF PAIN

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SOURSE OF PAINSOURSE OF PAIN

Cartilage AneuralCartilage Aneural

Innervated structures:Innervated structures:Synovium, Ligaments, Capsule, Muscle, Bone( Sub.)Synovium, Ligaments, Capsule, Muscle, Bone( Sub.)

NOT VISUALIZED BY X RAYNOT VISUALIZED BY X RAY

X RAY CHANGES AND PAIN SEVERITY X RAY CHANGES AND PAIN SEVERITY

POORLY POORLY CORRELATIONCORRELATION

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CLINICAL FEATURESCLINICAL FEATURES

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Mechanical painMechanical pain

Gelling painGelling pain

Night painNight pain

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KNEE:KNEE:BucklingBuckling

LockingLocking

Catching Catching

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PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

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DIAGNOSISDIAGNOSIS

CLINICALCLINICAL

No blood test routinely indicatedNo blood test routinely indicated

Synovial fluidSynovial fluid

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DIAGNOSISDIAGNOSIS

X Ray:X Ray:Hand and hip painHand and hip painknee if:knee if:

-- Not typical symptom Not typical symptom -- Pain persists after effective treatment Pain persists after effective treatment

Poorly correlation with pain severityPoorly correlation with pain severity

MRI:MRI: Not indicated Not indicated - - Meniscal tear in most patientsMeniscal tear in most patients

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RADIOLOGYRADIOLOGY

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HAND OAHAND OA

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HAND OAHAND OA

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HIP OAHIP OA

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KNEE OAKNEE OA

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SPINE OASPINE OA

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HALLUS RIGIDUSHALLUS RIGIDUS

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TREATMENTTREATMENT

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TREATMENTTREATMENT

NON PHARMACOTHERAPYNON PHARMACOTHERAPYMainstay of therapyMainstay of therapy

Weight loss: Weight loss:

-- Each Kg of weight: Load in knee 3-6 fold Each Kg of weight: Load in knee 3-6 fold

-- Symptom of Knee & Hip OA Symptom of Knee & Hip OA

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TREATMENTTREATMENT

NON PHARMACOTHERAPYNON PHARMACOTHERAPYAvoiding overload the jointAvoiding overload the joint

-- Knee & Hip Cane in opposite hand Knee & Hip Cane in opposite hand

Exercise:Exercise:

-- Age Age

-- Disuse Disuse

-- Arthrogenous inhibition Arthrogenous inhibition

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TREATMENTTREATMENT

NON PHARMACOTHERAPYNON PHARMACOTHERAPYDegree of weakness correlate strongly with:Degree of weakness correlate strongly with:

-- Severity of pain Severity of pain

-- Physical limitation Physical limitation

Correction of malalignment Correction of malalignment

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TREATMENTTREATMENT

PHARMACOTHERAPYPHARMACOTHERAPYAcetaminophenAcetaminophen

NSAIDNSAID

Injection Injection

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PATHOLOGYPATHOLOGY

SYNOVIUM:SYNOVIUM:Edematous and inflamed Enzymes Edematous and inflamed Enzymes

CAPSULE:CAPSULE:Stretch, edematous and fibroticStretch, edematous and fibrotic

BCP AND CPPD:BCP AND CPPD:Most joints with end-stage OAMost joints with end-stage OA

1 IN THE NAME OF GOD. 2 OSTEOARTHRITIS 3 EPIDEMIOLOGY.

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Transcript of 1 IN THE NAME OF GOD. 2 OSTEOARTHRITIS 3 EPIDEMIOLOGY.