Osteoarthritis

Osteoarthritis types of osteoarthritis treatment of osteoarthritis

1. Osteoarthritis By Bapan Paul

2. What is Arthritis? Acute or chronic inflammation of a joint, often accompanied by pain and structural changes and having diverse causes, as infection, crystal deposition, or injury

3. Osteoarthritis Osteoarthritis is non inflammatory degenerative condition of joints characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.

4. Development of Osteoarthritis

5. Types of Osteoarthritis

6. Risk Factors PRIMARY Age Gender Obesity High Bone Mass Mechanical : Repetitive bone use squatting SECONDARY Injury to joint : Traumatic or inflammatory Heamoartharosis Congenital/Developmental Neuropathic joint Metabolic ( Paget's Disease)

7. Macro structural & Pathological Changes Macro structural Loss of articular cartilage Subchondral cyst Osteophytes Sclerosis Muscle wasting Pathological Cartilage Fibrilation Subchondral new bone Myxoid degeneration Trabecular compression

8. Sign & Symptoms Pain Tenderness Stiffness Loss of flexibility Grating sensation C repitus Bone spurs

9. Knee OA The classical criteria for OA of knee is based upon the presence of knee pain plus at least 3 of the following 6 clinical characteristics Age >> 50 years Morning stiffness for < 30 minutes Crepitus on active motion of knee Bony tenderness Bony enlargement No palpable warmth

10. Hand OA The classical criteria for OA of hand is based upon the presence of hand aching or stiffness plus at least 3 of the following 4 features Hard tissue enlargment of 2 or more of 10 selected joint. The 10 selected joints are the second and third distal interphalangeal (DIP) joints, second and third proximal interphalageal (PIP) joints and the first carpometacarpal (CMC) of both hands. Hard enlargement of two or more DIP joints. Fewer than 3 swollen metacarpophalangeal (MCP) joints. Deformity of atleast 1 of the 10 selected joints.

11. Hip OA The presence of hip pain plus at least two of the following 3 features ESR of less than 20mm/h Radiographic osteophytes (femoral or acetabular ) Joint space narrowing on radiography (superior, axial or medial)

12. Spine OA Most common at C5, T8 and L3 OA of spine  is a breakdown of the cartilage of the joints and discs in the neck and lower back . OA  produces spurs that put pressure on the nerves leaving the spinal column.

13. Diagnosis Pain Radiography MRI Bone Scanning Synovial Fluid Analysis

14. Therapeutic Approach to Osteoarthritis

15. Therapeutic Approach to Osteoarthritis Acetaminophen Dose 650 to 1000 mg up to 4 times per day NSAID Therapy Short acting NSAIDs (ibuprofen ) Long acting NSAIDs ( diclofenac , naproxen , nabumetone ) – greater relief COX2 inhibitors ( celecoxib ) Opioids Only when acetaminiphen or NSAIDs fail Starts with low dose Tramadol and Duloxetine Diacerein Blocks interleukin-1 Disease modifier for OA. Daicerein increase proteoglycans and hyaluronan

16. NSAID - MOA

17. Opioids - MOA

18. Diacerein - MOA 1. Matrix metalloproteinases

19. Complementary and Alternative Medicines Intra articular injection for corticosteroids or hyaluronic acid Acupuncture Heat and Cold Glucosamine/Chondroitin Synovial Fluid Supplements Capsaicin Cream Diclofenac Gel

20. Surgical Arthroscopy Osteotomy Arthroplasty