Osteoarthritis Overview and Risk Factors

Osteoarthritis

• Progressive, degenerative disease of the joints
• Most commonly affects hips, knees, hands (constantly load bearing)
• May be secondary to a condition or trauma, but many cases have no single cause
• Considered the most common form of arthritis
• Age, obesity, injury, joint overuse are risk factors
• Genetic traits, previous injuries (e.g., meniscus tears or ligament strains) also play a role

Risk Factors

• Age
• Obesity
• Trauma (might kill more stress on the joints)
• Overuse of the joint
• Genetic traits (degeneration decreasing overtime, child birth, bone changes, biomechanical load is different)

Synovial Joint Structure

• Synovial fluid is key for the joints in the body
• Synovial fluid is important for reducing friction, supporting the nourishment of the cartilage
• Cartilage is created by chondrocytes important for maintaining the cartilaginous matrix

Cartilage Osteoarthritis

• Cartilage becomes yellow, dull, and granular, increasing friction between bones
• Chronic inflammation of the joint

Clinical Manifestations

• Pain (gradually present or uncertain) (Early changes in symptomatic OA), stiffness, and limited range of motion (especially in the morning)
• Joint creaking or grinding.
• Swelling in the joint
• Tenderness to the touch
• Difficulty with movement.
• Bone spurs (outgrowths of bone that occur near the joint) or cysts

Early Changes in OA

• Healthy joint: smooth, articular cartilage, which provides a cushioned surface for smooth bone movement
• Later changes in OA: decrease in the thickness of the articular cartilage, increased production of synovial fluid, and development of bone spurs or cysts

Review of Hand Joints

• Carpal bones form the wrist joint
• Bone cyst is a hollow part of bone
• Bone spur is the bump in joint.

OA Commonly Affected Joints

• Joints that bear the most heavy load (e.g., knees, hips, spine)
• All body weight and movements also affect the joints in the back (spine), shoulders, hips

Evaluation

• History (everything has been going on in factor, joint stiffness, functional limitations, previous injuries?)
• Physical Exam (palpate/observe joint involvement, assess tenderness, range of motion)
• X-ray
• Blood tests

Management (Conservative)

• Non-pharmacological therapy
• Balance rest and activity (exercise has to be similar function to avoid problems)
• Medications to reduce inflammation (mild anti-inflammatory drugs or supplements)
• Heat or cold application

Management (Surgical)

• Medications that reduce inflammation
• Joint replacement (e.g., arthroplasty)

Management (Drugs)

• Cyclooxygenase inhibitors (COX inhibitors) (moderate to severe), e.g., NSAIDs, topical (if only a few joints are involved).