OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH. Assignment: 1. Age 2. Weight & height (BMI) 3. Joint...
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Transcript of OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH. Assignment: 1. Age 2. Weight & height (BMI) 3. Joint...
OSTEOARTHRITIS (OA)
Rogelio A Balagat MDASMPH
Assignment:
1. Age2. Weight & height (BMI)3. Joint pain (VAS)4. Joint deformity
Definition of OA
Joint failure•failure of protective mechanisms •cartilage loss •subchondral bone changes •osteophytes •capsule stretching •mild synovitis•periarticular muscle weakness
JOINT INJURY
JOINT REPAIR
-OA +OA
FAILURE OF PROTECTIVE MECHANISMS
WEIGHT-BEARING
Main joint protector
Cartilage•Avascular•Aneural•Load-bearing•Low friction
Joint protectors
•Joint fluid lubrication•Muscle-skin sensory afferent nerve mechanoreceptors•Muscle-tendon co-contraction•Subchondral bone shock-absorption
CATABOLISM SYNTHESIS
CHONDROCYTE
↑AGE PREVIOUS DAMAGE↑WEIGHT
PRIMARY OA• aging bone & cartilage• mechanical factors accumulated microtrauma lower limb malalignment• genetic factors
SECONDARY OA • mechanical joint incongruity congenital, genetic, developmental disorders prior joint trauma/surgery• prior inflammatory joint disease• bleeding dyscrasia• neuropathic joint disease• excessive intra-articular steroid injections• endocrinopathies & metabolic disorders acromegaly Cushing’s disease gout/pseudogout
•Chronic•>40, F>M, ↑weight•Non-inflammatory•DIP, CMC1, Knee, Hip•Use-related pain onset of movement after activity improved with rest
•Bouchard’s nodes (PIP)•Heberden’s nodes (DIP)•“squared-off” base of thumb •malalignment
•swelling•crepitus
KNEE OAHAND OA
HIP OA• pain in groin or inner thigh• antalgic gait, limited/loss of flexion, extension, rotation• predisposing conditions congenital hip dysplasia, avascular necrosis
SPINE OA apophyseal joints, disc/vertebral bodies (spondylosis)
• paraspinal pain, spasm• radicular symptoms cervical neck pain, radiates to shoulder, upper back, distal arm weakness, paresthesias of hand, arm
SPINE OAlumbar low back pain, radiates to buttocks, legs, feet cauda equina syndrome neurogenic claudication• cord compression- leg weakness; gait, balance problems• mechanical compression of vital structures- dysphagia, cough, headache, vertigo
Radiography
Bone formation(-) bone erosion
DIFFERENTIAL DIAGNOSIS
•Rheumatoid Arthritis Monoarticular Polyarticular •Spondyloarthropathies Psoriatic arthritis Reactive arthritis Inflammatory bowel disease Ankylosing spondylitis
DIFFERENTIAL DIAGNOSIS
•Crystal-induced arthritis Gout•Other disorders infectious arthritis periarticular tendenitis or bursitis•Rare neoplastic synovitis pigmented villonodular synovitis neoplastic metastasis to juxta-articular bone
PHARMACOLOGIC NON PHARMACOLOGIC
SURGICALINTERVENTION
Considered as theCORNERSTONE in the
Management of OA
Considered as
ADJUNCTS to Non-pharmacologic
Management
Management
NON PHARMACOLOGIC
Psychosocial Interventions
Patient Education
Physical Modalities
Thermal Modalities
Exercise
Supportive Devices
Modifications in ADL
Psychosocial Measures
PHARMACOLOGIC
Topical Agents
Intra-articular Agents
Oral (Systemic) Agents
Symptom Modifiers
Potential Disease Modifiers
Thanks