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

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