Osteoarthritis

Dr. Faik AltıntaşYeditepe Üniversitesi Tıp Fakültesi

Ortopedi ve Travmatoloji AD

OsteoarthritisOsteoarthritis (OA) is a degenerative joint

disease, occurring primarily in older persons, characterized by Erosion of the articular cartilage, Hypertrophy of bone at the margins

(osteophytes), Subchondral sclerosis, Range of biochemical and morphologic alterations

of the synovial membrane and joint capsulePathologic changes in the late stages of OA

include softening, ulceration, and focal disintegration of the articular cartilage; synovial inflammation also can occur

Osteoporosis

OsteoarthritisCatabolism of cartilage results in release of breakdown

products into synovial fluid which then initiates an inflammatory response by synoviocytes

These antigenic breakdown products include: chondrointon sulfate, keratan sulfate, PG fragments, type II collagen peptides and chondrocyte membranes

Activated synovial macrophages then recruit PMNs establishing a synovitis

They also release cytokines, proteinases and oxygen free radicals (superoxide and nitric oxide) into adjacent and synovial fluid

OsteoarthritisProinflammatory cytokines are believed to play a

pivotal role in the initiation and development of the disease process

Antiinflammatory cytokines are found in increased levels in OA synovial fluid

TNF-α and IL-1 appear to be the major cytokines involved in OA

Other cytokines involved in OA are: IL-6, IL-8, leukemic inhibitory factor (LIF), IL-11, IL-17

Osteoarthritis

SymptomsAcute PainLoss of abilityStiffness Crackling noise (called "crepitus") The joints may also be filled with

fluid (Effusion)

Osteoarthritis OA commonly affects the hands, feet, spine, and

the large weight bearing joints, such as the hips and knees

In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly.

OA at the toes leads to the formation of bunions, rendering them red or swollen.

OA is the most common cause of water on the knee, an accumulation of excess fluid in or around the knee joint

OsteoarthritisClassification

Primary OAIdiopathicWhen the cause is not known (as in the large

majority of cases)

Secondary OAWhen the cause is another disease or

condition Infection,Deformity InjuryAbnormal use of a jointMetabolic disorder (hemochromatosis, Wilson's

diseaseDisorder that damages joint cartilage (rheumatoid

arthritis, gout)

OsteoarthritisRisk Factors and Possible

Causes:AgeFemaleObesityMuscle weaknessGenetics

OsteoarthritisDiagnosis Normally done through x-raysLoss of cartilage, subchondral

sclerosis, subchondral cysts from synovial fluid entering small microfractures under pressure, narrowing of the joint space between the articulating bones, and bone spur formation (osteophytes)

OsteoarthritisTreatment

The process of clinically detectable osteoarthritis is irreversible, and typical treatment consists of medication or other interventions that can reduce the pain of OA and thereby improve the function of the joint

Gene therapy has future for cure

ConservativeMedical Surgical

OsteoarthritisConservative Treatment

Weight controlAppropriate rest and exerciseTENSMechanical support devices

Knee braces Cane Walker Applying local heat before, and cold packs after exercise,

can help relieve pain and inflammation, as can relaxation techniques

Schock absorbing heels and pads

OsteoarthritisMedical Treatment Analgetics

Acetominophen

Metamizol sodium

Nonsteroidal anti-inflammatory drugs (NSAIDs) (traditional and COX 2 selective)

Both relieve pain and reduce inflammation.

Topical pain relievers (creams, gels, and sprays)

Temporarily relieve arthritis pain and reduce inflammation in joints close to the surface of the skin

Antidepressants

Glucosamine , chondroitin sulfate, MSM

Diacetylrhein

Intraarticular corticosteroid injections

Viscosupplementation Hyaluronate

OsteoarthritisSurgical TreatmentArthroskopic Debridement

For meniscal tears

Loose bodies

Catilage repair or debridement

Diluation of enflamatory substances and enzymes

Osteoarthritis

Surgical TreatmentCorrection osteotomy for malalignment

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Osteoarthritis

High Tibial Osteotomy

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Osteoarthritis

Surgical TraetmentArthroplasty

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Osteoarthritis

Total knee arthroplasty

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OsteoarthritisArthroplasty

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Osteoarthritis

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