PM3PY2 Osteoarthritis and Gout 2024 PDF

PM3PY2 OSTEOARTHRITIS AND GOUT Professor Kat Bicknell Copyright University of Reading LEARNING OUTCOMES Describe the underlying pathophysiology of osteoarthritis (OA) and gout Outline the signs and symptoms of these conditions and the clinical investigations that are used for their diag...

PM3PY2 OSTEOARTHRITIS AND GOUT Professor Kat Bicknell Copyright University of Reading LEARNING OUTCOMES Describe the underlying pathophysiology of osteoarthritis (OA) and gout Outline the signs and symptoms of these conditions and the clinical investigations that are used for their diagnosis. Discuss the pharmacological and non-pharmacological treatments available for OA. Discuss the pharmacological and the non-pharmacological treatments available for gout. OSTEOARTHRITIS (OA) Osteoarthritis (OA) is the most common form of arthritis and most common musculoskeletal condition Used to be considered to be due to “wear and tear” but now is recognised as a metabolically active disease process affecting the whole joint (cartilage, bone, capsule, muscle). OA is a ‘disease of synovial joints’, characterised by: ‒ Progressive destruction/loss of articular cartilage. ‒ Changes in subchondral bone: accompanying periarticular bone response i.e. hardening (sclerosis) and refashioning of underlying bone and formation of osteophytes (bony projections). ‒ Synovial inflammation (less aggressive than in rheumatoid arthritis, RA). ‒ Changes in periarticular muscle. ‒ Pain (and stiffness). OA IN THE KNEE HEALTHY KNEE OSTEOARTHRITIS KNEE Cartilage loss and exposed bone Synovial inflammation Joint space narrowing Thickened joint capsule Osteophytes * Degenerative meniscus Bone cysts and subchondral sclerosis OA is the most common *Bony type of non- outgrowths inflammatory arthritis which appear at joint margins. OA: DISEASE PROGRESSION Initial Repair: ‒ Proliferation of chondrocytes which synthesise the extracellular matrix (ECM) of bone (ECM major components: type II collagen and aggrecan). Early stage OA: ‒ Degradation of ECM exceeds chondrocyte activity resulting in net breakdown and loss of articular cartilage in joint. ‒ Subchondral bone remodelling increases. Intermediate stage OA: ‒ Failure of ECM synthesis and increased breakdown of cartilage. Late stage OA: ‒ Extreme or complete loss of articular cartilage, joint space narrowing. ‒ Bony outgrowths (new bone) appear at joint margins (osteophytes). ‒ Bone remodelling decreases, subchondral bone sclerosis OA VERSUS RA OA: Cartilage loss, eventually joint is ‘ground down’ due to injury/overuse. RA: Overactive immune system, chronic inflammation OA: RISK FACTORS Increasing age: ‒ OA is uncommon in people 65 year olds: prevalence is 68% in women and 58% in men. Gender: ‒