OSTEOARTHRTITI
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• Osteoarthritis OA is a degenerative joints disease,
characterized by Breakdown of articular cartilage and
proliferative changes of surrounding bones.
• Associated with Synovial inflammation
• OA is a chronic disease of the musculoskeletal system,
without systemic involvement
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It is a chronic condition characterized by the breakdown of
the joint’s cartilage which causes the bones to rub against
each other, causing stiffness, pain and loss of movement in the
joint.
Osteoarthritis is by far the most common type of arthritis.
Osteoarthritis (OA) was previously thought to be a normal
consequence of aging, OA results from a complex interplay of
multiple factors, including joint integrity, genetic
predisposition, local inflammation, mechanical forces, and
cellular and biochemical processes.
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Individuals younger than 60 years have 27% to have OA,
> 70 have 44%
The symptoms of OA usually appear in middle age and
almost everyone has them by age 70.
Before age 55, the condition occurs equally in both
sexes.
However, after 55 it is more common in women.
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RISK FACTORS FOR PRIMARY OA
• Age
• Sex
• Obesity
• Genetics
• Trauma (daily)
Trauma
Joint disorders including osteonecrosis, RA , gouty arthritis,
septic arthritis, and Paget disease of bone
Congenital or developmental disorders
Charcot arthropathy
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OA: Symptoms and Signs
• Joint instability
• Pain is related to use
• Deformity
• Minimal morning stiffness
(<20 min)
• Crepitus
• Range of motion decreases
• Variable swelling (effusion)
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Control Pain & swelling
To prevent the disabilities
Improve the quality of life
To prevent the progression process
To educates the patient about his role in the 19
management team
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• WEIGHT LOSS: Canes & walkers
• REST
• PHYSICAL THERAPY & ORTHOSES:
therapeutic shoes & Knee taping
Braces, splints ,
• EXERCISE : Programs, Symptomatic relief, joint protection, disability
prevention, compliance, aerobic vs resistance.
• PATIENT PSYCHOSOCIAL & SUPPORT
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• Used only if not responded to the
nonpharmacotherapy
• Not required during periods when
symptoms are absent or too minimal
• The major medications include
analgesics, such as Acetaminophen,
NSAIDs & intraarticular glucocorticoids.
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Most people with Osteoarthritis will use
Drug Therapy to ease the symptoms of the
disease.
Most Drugs focus mainly on Relieving Pain,
but some are targeted at other symptoms
and slowing disease progression.
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•Initial Noninflammatory OA:
In patients with noninflammatory OA, we recommend initiating
drug treatment with acetaminophen (paracetamol, APAP,
especially in patients with only mild to moderate pain (Grade
1A).
• NSAIDS:
In patients with an inadequate response to APAP, with
inflammatory OA, or with severe pain, we recommend the use of
a nonselective NSAID or COX-2 selective NSAID (coxib) in the
lowest dose and for the shortest time necessary for adequate
relief or symptoms (Grade 1B).
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• Topical anagesics
In patients with mild to moderate pain who are unable to tolerate or have
contraindications to oral NSAIDs, we suggest a topical NSAID
(eg, diclofenac gel
In patients with inadequate benefit from oral and topical NSAIDs, we
suggest the topical application of capsaicin as an adjunct to these
measures, or as an alternative therapy, rather than use of an opioid
(Grade 2C).
• Intraarticular glucocorticoids injections:
In patients with moderate to severe pain affecting one or a few joints,
which is not adequately relieved by orally administered drugs and in
patients with inflammatory OA and a contraindication to NSAIDs, we
suggest the use of intraarticular glucocorticoids rather than opioid
analgesics or other intraarticular agents (Grade 2B).
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• Recurring joint swelling or inflammation:
Should be evaluated for crystal disease or other arthropathies
by doing synovial fluid arthrocenthesis
• Resistant to initial pharmacotherapy
these therapies include:
• Opioid analgesics
• Intraarticular hyaluronans
• Glucosamine and chondroitin compounds
• Glucosamine or chondroitin compounds 26
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Thank
You…………..
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