osteoarthritis
OSTEOARTHRITIS

Osteoarthritis is a chronic progressive disease where there is degeneration & loss of articular cartilage that occurs together with new bone formation at the joint surfaces and margins, that causes pain and deformity.

The patient experiences pain, stiffness, decreased movement, inflammation and crepitus.

The pain is usually aggravated by pain and relieved by rest.

Introduction

  • A clinical syndrome of joint pain with different degrees of limitation in function & decreased quality of life
  • Most common form of arthritis
  • May not be secondary to aging & does not automatically progress
  • Process of progressive softening or localizing loss of cartilage accompanied by inadequate metabolic repair
  • Most often occurs in the hands (ends of the fingers & thumb), spine (neck & lower back), knees & hips
  • Classified as primary or secondary based on the cause or major predisposing factor; both have altered cartilage physiology
    • Primary OA is the most common with no known cause
    • Secondary OA has identifiable etiology but pathologically similar to primary OA
      • Common causes are metabolic diseases (eg hemochromatosis, acromegaly), anatomic causes (eg developmental hip dislocation), trauma (joint surgery, intra-articular fractures, ligament or meniscus damage, malunion), or complication of an inflammatory disorder (septic arthritis, ankylosing spondylitis)

Signs and Symptoms

  • Cardinal features of OA are pain, stiffness, decreased movement, inflammation, crepitus & absence of systemic signs & symptoms like fever
    • OA pain is usually aggravated by activities & relieved by rest; not common to occur at night or during rest but may be experienced by patients after several hours of using joints, in advanced OA & in acute inflammatory flare
    • Stiffness occurs in the morning, after period of rest, or in the evening which usually resolves within 10 minutes of activity

Risk Factors

Risk Factors

Age

  • >80% of individuals older than 75 years are affected; not common in patients <40 years old unless with history of trauma

Female Gender

  • Higher risk for knee OA after menopause due to decreased estrogen

Genetic Predisposition

  • The influence of genetic factor varies in different subsets of osteoarthritis, ranging from 40-70%

Obesity

  • Increases risk for symptomatic & progressive OA
    • Increases the risk for knee OA due to the increased mechanical stress on the joints & altered joint biomechanics secondary to changes in posture, gait & level of physical activity
    • Increases stiffness in the subchondral bones & facilitates cartilage breakdown

Joint Trauma or Malalignment

  • Results in rapid development of OA or starts the process causing symptomatic OA later in life
  • Repetitive, high-impact sports are strongly related to joint injury which increases the risk for lower extremity OA
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