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