PHTH1110 003 Degenerative Conditions Osteoarthritis - Wright.pdf

DEGENERATIVE CONDITIONS OSTEOARTHRITIS FOCUS Dr Dean Everett Wright 2019 ARTHRITIS BROAD definition JOINT pain destruction functional loss OSTEOARTHRITIS most common form arthritis very costly to government/individual productive loss/ treatment cost affects physical health* affects mental health OA...

DEGENERATIVE CONDITIONS OSTEOARTHRITIS FOCUS Dr Dean Everett Wright 2019 ARTHRITIS BROAD definition JOINT pain destruction functional loss OSTEOARTHRITIS most common form arthritis very costly to government/individual productive loss/ treatment cost affects physical health* affects mental health OA — ENTIRE JOINT results from … inflammation breakdown of articular cartilage & failed repair secondary effects/ hyaline articular cartilage, subchondral bone, ligaments, capsule, synovium, periarticular muscles., periosteal nerves chronic pain/ stress/ depression OA SYSTEMIC FACTORS AGE/ sex: 10% M>60/ 20% F>60 genetics. site: knee> hands > hips systemic factors obesity /metabolic synd knee OA also hand OA BMD BMD ⬆︎ fibre ⬆︎ diets ⬆︎ ⬆︎ vit D ⬆︎ soy protein OA? joint factors bone/joint shape/ knock knee/ bow legs muscle strength ….. FAI joint level factors bone/joint shape ….. muscle strength joint alignment ……. varus/ valgus ( knee. hallux) joint level factors occupation/ sports injury/surgery /sports ACL/meniscus/ cartilage in knee occupation examples labourers & farmers high-impact sport COMORBIDITIES OA & Atherosclerosis linked small CVS disease/ ⬆︎ death risk CVA PATHOLOGY DEVELOPMENT OA CARTILAGE ➜ POTHOLES cells swell surface/ rough/ fibrillated/ fissured/ eroded land of wood and potholes INEVITABLE PROGRESSION N/ ARTICULAR CARTILAGE distributes loads/ frictionless motion taxi??? soft by probing partial thickness fibrillation partial thickness fibrillation eburnated to bone ➡︎ ➡︎ OA & BONE ABNORMAL load thinning/ subchondral cysts thickening sclerosis/ formation > breakdown at margins/ entheses/ osteophytes INEVITABLE PROGRESSION NERVES GET PINCHED OFFICE ASSESSMENT/ MANAGEMENT OFFICE ASSESSMENT history/ exam ± imaging function/ QOL/ mood/ social / occupation/ leisure/ sleep co-morbidities therapy SYMPTOMS pain swelling ± warmth morning stiffness creaking PAIN knee OA pain is typically weight-bearing (mechanical) nociceptive more severe, frequent, or unpredictable/ neuropathic flare-up: pain/ limp/ effusion SWELLING synovitis more painful IMAGING unnecessary for diagnosis OA consider if presentation atypical both Xray & MRI only moderate associations with pain hip knee hand pain + 2/3 pain + 5/6 painful stiff hand + 2/3 ESR < 20 age >50