UCL School of Pharmacy
PHAY 0011: BST 4
Osteoarthritis
Osteoarthritis
qExtremely common, associated with age:-
Ø50% affected by age 65 in at least one joint
Ø10% with loss of function (disability)
Osteoarthritis
Muscle
Bone
Synovium
Lubricant
cartilage Capsule
Bone
Ligament Tendon
Normal joint
Osteoarthritis
Osteophyte
formation
Bone
Cartilage Synovium
rough and thickened and
thinning slightly inflamed
Bone
Narrowed
joint space Capsule
thickened and
stretched
Arthritis
Osteoarthritis
Angulation
Exposure of subchondral bone
of bone
® eburnation & cyst formation
Bone
Little
cartilage
remaining
Bone
Advanced arthritis (deformed joint)
Calcification (Ca pyrophosphate deposits in synovium) = ‘pseudogout’
Osteoarthritis - pathogenesis
qNot fully understood (recurring theme…)
ØJoint (over)use (abnormal ‘wear and tear’)
ØMuscle weakness (esp. in elderly)
ØObesity
ØGenetic predisposition
qSymptoms and signs vary from patient to patient
ØStiffness (start or end of day)
ØPain
ØCreaking or crackling of affected joint (crepitus)
ØVisible remodelling of joint
ØSymptoms gradually worsen OR can plateau
Non-pharmacological treatment ‘individual’
(ie rest if rest helps, exercise if exercise helps)
Heberden’s and Bouchard’s nodes
Heberden’s nodes
Bouchard’s nodes
Source: Frewin et al. (1997) BMJ 314:360 314 360
Osteoarthritis - treatment
q Non-pharmacological
q Paracetamol (± weak opioid, though not ideal)
q NSAIDs (non-selective or COX2 selective)
q Topical NSAIDs
q Topical capsaicin
q Supplements (e.g. glucosamine)
q Intra-articular steroids (care: septic arthritis, avascular necrosis)
q Surgery
Dietary supplementation
qGlycosaminoglycans
OH q Chondroitin: cartilage
q Hyaluronic acid: synovial fluid
O and cartilage
qMixed evidence of efficacy in OA
OH OH OH qNot recommended
q Radiographical changes?
NH2 q Evidence of any effect is weak
q Need to consider shellfish allergy
Glucosamine
UCL School of Pharmacy
PHAY 0011: BST 4
Thank you!