Osteoarthritis: OA Janet Pope MD MPH FRCPC

Goals Identify the most common joints affected in OA Differentiate OA from RA Describe the most common treatments for OA including non-pharmological

Case: Diane This is a 62 year old woman with 3 kids She has had on-going bilateral knee pain for the past 3 years It flares on and off It tends to be worse when she is active At times she has difficulty sleeping because of knee pain

Diane has made some positive moves She manages to walk every morning when her knees are “feeling good” She lost 28 lbs and has kept it off for the last 5 years She is otherwise healthy and takes no other medications with the exception of occasional acetaminophen for her knees

OA Knee Xrays Often we order weight bearing views AP knees standing Joint space narrowing Osteophytes, sclerosis, bony cysts Joint space narrowing may be assymetrical Malalignment (ex valgus or varus deformity)

Here are Diane’s Hands

Diagnosis Diane has osteoarthritis –OA / degenerative arthritis Osteoarthritis is the most common form of chronic arthritis

Osteoarthritis: Definition A joint disease characterized by: –Pain that typically worsens with weight bearing and activity and improves with rest –Morning stiffness and gelling of the involved joint after periods of inactivity –Tenderness on palpation, bony enlargement, crepitus on motion, and/or limitation of joint motion –There may be joint swelling and heat ACR Recommendations: Arthritis Rheum 2000; 43(9):

Osteoarthritis Facts OA affects 3,000,000 (1 in 10) Canadians 1 OA is associated with significant costs: 2 –Direct (e.g., drugs, healthcare resource use) –Indirect (e.g., lost employment time, costs of informal caregiving) Under treatment leads to significant pain and loss of quality of life 1 & 2 - Arthritis Society of Canada:

Osteoarthritis: Clinical Characteristics OA is common It is not always symptomatic Usually insidious onset Usually less than a half hour of am joint stiffness Younger age Men>women Older age Women>men Worse with activity Better with rest

Bony Enlargement DIP bony enlargement Heberden’s nodes PIP bony enlargement Bouchard’s nodes

Distribution of Joints Hands: –DIP, PIP, 1 st CMC joints Hip Knee Feet: –First MTP Spine –Cervical, lumbar

OA RA

First CMC OA –squaring at base of thumb