Musculoskeletal System >
Osteoarthritis
“Disease of joint degeneration and inflammation“
Risk Factors
- Modifiable:
- Obesity
- Non-Modifiable:
- Increasing Age
- Previous Joint Trauma
- Sex (female)
- Bone deformity
- Genetics
- Repetitive joint stress
Aetiology
- Primary osteoarthritis is idiopathic/related to ageing. Secondary osteoporosis is the result of another disease or trauma/risk factors
Pathophysiology
- Stimulation of macrophages => release of inflammatory cytokines => ↑WBC in synovial joint and ↑pain => release of proteases => cartilage degradation
- Cytokines => ↑osteoblast bone formation =>subchondral sclerosis =>osteophytes (bony protrusions)
- ↓reduction in synovial space and fluid => bone rubbing/friction => degeneration
Clinical Presentation
- Joint pain
- Joint stiffness
- Joint stiffness at rest/mornings
- Crepitus
- Muscle wasting
- Knee effusion
- Deformity in severe cases (genu varus or valgus)
Investigations
- X-ray
- Arthrocentesis
- Arthroscopy
- To rule out differentials =>ESR, RF, Anti-CCP
Management
- Conservative:
- Weight loss
- Muscle training
- Physical therapy
- Heat/cold compress
- Brace
- Education
- Medical:
- Paracetamol
- Topical NSAID
- Topical capsaicin
- Oral NSAID (+ PPI)
- Tramadol
- Intra-articular corticosteroid injections
- Viscosupplementation
- Surgical:
- Joint replacement
Complications
- Chronic pain leading to reduced QOL
- Depression
- Sleep disturbance