1. OSTEOARTHRITIS DEGENERATIVE JOINT DISEASE

2. DEFINITION
Osteoarthritis OA is a degenerative disease of diarthrodial (synovial) joints, characterized by
Breakdown of articular cartilage
and proliferative changes of surrounding bones

3. EPIDEMIOLOGY Osteoarthritis(OA) is the most common joint disease
OA of the knee joint is found in 70% of the population over 60 years of age
Radiological evidence of OA can be found in over 90 % of the population

4. LIMITED FUNCTION OA may cause functional loss
Activites of daily living
Most important cause of disability in old age
Major indication for joint replacement surgery

5. CHARACTERISTICS OF OA
OA is a chronic disease of the musculoskeletal system, without systemic involvement
OA is mainly a noninflammatory disease of synovial joints
No joint ankylosis is observed in the course of the disease

6. CLASSIFICATION OF OA Primary OA Secondary OA
Etiology is unknown Etiology is known

7. AGE
Primary OA > 40 years
Direct correlation
Aging process

8. RISK FACTORS FOR PRIMARY OA
Age
Sex
Obesity
Genetics
Trauma (daily)

9. SECONDARY OSTOARTHRITIS
Trauma
Previous joint disorders;
Congenital hip dislocation
Infection: Septic arthritis, Brucella, Tb
Inflammatory: RA, AS
Metabolic: Gout
Hematologic: Hemophilia
Endocrine: DM

10. ETIOLOGY OF OA
Cartilage properties
Biomechanical problem

12. STRUCTURE OF JOINT CARTILAGE
Collagen (Type 2)
Proteoglycan
- Hyaluronic acid
- Glycoseaminoglycan
Water
Condrocyte
Regeneration and Degeneration

13. PATHOLOGY OF OA
Fibrillation
Eburnation
Osteophytes
Subcondral cysts

14. RADIOLOGIC FINDINGS OF OA
Narrowing of joint space
(due to loss of cartilage)
Osteophytes
Subchondral (paraarticular) sclerosis
Bone cysts

15. DIAGNOSIS OF OA CLINICAL FINDINGS Joint pain + RADIOLOGIC FINDINGS
Osteophytes

16. CLINIC OF OA SIGNS AND SYMPTOMS
Joint pain - degenerative
Stiffness following inactivity – 30 min
Limitation of ROM – later stages
Deformity – restricition of ADL

17. OA OF KNEE JOINT (GONARTHROSIS)
More common in obese females
over 50 years of age
Joint stiffness (<30 minutes)
Mechanical pain
Physical examination findings: Crepitus
Pain on pressure
Painful ROM and functional limitation
Limitation of ROM in later stages of OA (first extension)
Laboratory analysis within normal limits

18. OA OF HIP JOINT More common in males over 40 years of age
Joint stiffness
Pain of hip, gluteal and groin areas radiating to the knee (N obturatorius)
Mechanical pain
Limited walking function

19. X-RAY OF HIP OA

20. Peripheral Joints
Hands
Feet

21. ETIOPATHOGENESIS OF OA
Age,gender
Local
Genetic OA biochemical effects
Other factors

22. ETIOPATHOGENESIS OF OA
Dysfunction of joint cartilage
Condrocyte function: 1- Degredative enzymes
(metalloproteases)
2- Inhibitors
Degeneration and regeneration functions are balanced
IL-1  , degredative enzymes + synovial inflammation results: Breakdown of cartilage

23. TREATMENT OF OA
Symptomatic treatment
Structure modifying treatment
Surgical treatment

24. STRUCTURE MODIFYING TREATMENT
Hyaluronic acid injection (HA)
Glycose amino glycans (GAG)

25. PRIMARY PREVENTION OF OA ??
Regular exercises
Weight control
Prevention of trauma

26. AIMS OF OA TREATMENT Pain relief
Preservation and restoration of joint function
Education

27. Non-Pharmacologic Treatment of OA
Patient education
Weight loss (if overweight)
Aerobic exercise programs
Physical therapy
Range-of-motion exercises Muscle-strengthening exercises
Assistive devices for ambulation Patellar taping Appropriate footwear Lateral-wedged insoles (for genu varum)
Bracing
Occupational therapy
Joint protection and energy conservation

28. PHARMACOLOGIC TREATMENT OF OA
Oral Systemic Medical Agents
- Analgesics (acetaminophen)
- NSAIDs
- Opioid analgesics
Intraarticular agents:
Hyaluronan
Glucocorticoids (effusion)
Topical agents

29. HAND OA - RESTING SPLINT

30. SYMPTOMATIC TREATMENT OF OA
Decrease of joint loading
- Weight control
- Splinting
- Walking sticks
Exercises
- Swimming
- Walking
- Strengthening
Patient education

31. INDICATIONS OF SURGICAL INTERVENTION
Severe joint pain,
resistant to conservative treatment methods
Limitation of daily living activities
Deformity, angular deviations, instability

32. QUESTIONS?