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Published byAlexandra Wheeler Modified over 10 years ago
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OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH
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Assignment: Age Weight & height (BMI) Joint pain (VAS) Joint deformity
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Definition of OA Joint failure failure of protective mechanisms cartilage loss subchondral bone changes osteophytes capsule stretching mild synovitis periarticular muscle weakness
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-OA +OA WEIGHT-BEARING FAILURE OF PROTECTIVE MECHANISMS JOINT INJURY
JOINT REPAIR -OA +OA
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Cartilage Avascular Aneural Load-bearing Low friction
Main joint protector Cartilage Avascular Aneural Load-bearing Low friction
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Joint protectors Joint fluid lubrication Muscle-skin sensory afferent
nerve mechanoreceptors Muscle-tendon co-contraction Subchondral bone shock-absorption
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CATABOLISM SYNTHESIS CHONDROCYTE
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↑AGE ↑WEIGHT PREVIOUS DAMAGE
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accumulated microtrauma lower limb malalignment genetic factors
PRIMARY OA aging bone & cartilage mechanical factors accumulated microtrauma lower limb malalignment genetic factors
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congenital, genetic, developmental disorders
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
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Chronic >40, F>M, ↑weight Non-inflammatory DIP, CMC1, Knee, Hip Use-related pain onset of movement after activity improved with rest
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KNEE OA HAND OA Bouchard’s nodes (PIP) Heberden’s nodes (DIP)
“squared-off” base of thumb malalignment swelling crepitus
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HIP OA pain in groin or inner thigh
antalgic gait, limited/loss of flexion, extension, rotation predisposing conditions congenital hip dysplasia, avascular necrosis
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SPINE OA disc/vertebral bodies (spondylosis) paraspinal pain, spasm
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
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SPINE OA lumbar 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
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Radiography Bone formation (-) bone erosion
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DIFFERENTIAL DIAGNOSIS
Rheumatoid Arthritis Monoarticular Polyarticular Spondyloarthropathies Psoriatic arthritis Reactive arthritis Inflammatory bowel disease Ankylosing spondylitis
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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
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Management PHARMACOLOGIC NON PHARMACOLOGIC ADJUNCTS to
Considered as ADJUNCTS to Non-pharmacologic Management Considered as the CORNERSTONE in the Management of OA SURGICAL INTERVENTION
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PHARMACOLOGIC NON PHARMACOLOGIC Psychosocial Interventions
Topical Agents Patient Education Intra-articular Agents Psychosocial Measures Oral (Systemic) Agents Physical Modalities Symptom Modifiers Thermal Modalities Potential Disease Modifiers Exercise Supportive Devices Modifications in ADL
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