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OSTEOARTHRITIS (OA) Rogelio A Balagat MD ASMPH
Assignment: 1. Age 2. Weight & height (BMI) 3. Joint pain (VAS) 4. Joint deformity
Definition of OA Joint failure failure of protective mechanisms cartilage loss subchondral bone changes osteophytes capsule stretching mild synovitis periarticular muscle weakness
JOINT INJURY JOINT REPAIR -OA +OA FAILURE OF PROTECTIVE MECHANISMS WEIGHT-BEARING
Main joint protector Cartilage Avascular Aneural Load-bearing Low friction
Joint protectors Joint fluid lubrication Muscle-skin sensory afferent nerve mechanoreceptors Muscle-tendon co-contraction Subchondral bone shock-absorption
PRIMARY OA aging bone & cartilage mechanical factors accumulated microtrauma lower limb malalignment genetic factors
SECONDARY OA mechanical joint incongruity congenital, genetic, developmental disorders prior joint trauma/surgery prior inflammatory joint disease bleeding dyscrasia neuropathic joint disease excessive intra-articular steroid injections endocrinopathies & metabolic disorders acromegaly Cushings disease gout/pseudogout
Chronic >40, F>M, weight Non-inflammatory DIP, CMC1, Knee, Hip Use-related pain onset of movement after activity improved with rest
Bouchards nodes (PIP) Heberdens nodes (DIP) squared-off base of thumb malalignment swelling crepitus KNEE OA HAND OA
HIP OA pain in groin or inner thigh antalgic gait, limited/loss of flexion, extension, rotation predisposing conditions congenital hip dysplasia, avascular necrosis
SPINE OA apophyseal joints, disc/vertebral bodies (spondylosis) paraspinal pain, spasm radicular symptoms cervical neck pain, radiates to shoulder, upper back, distal arm weakness, paresthesias of hand, arm
SPINE OA lumbar low back pain, radiates to buttocks, legs, feet cauda equina syndrome neurogenic claudication cord compression- leg weakness; gait, balance problems mechanical compression of vital structures- dysphagia, cough, headache, vertigo
Radiography Bone formation (-) bone erosion
DIFFERENTIAL DIAGNOSIS Rheumatoid Arthritis Monoarticular Polyarticular Spondyloarthropathies Psoriatic arthritis Reactive arthritis Inflammatory bowel disease Ankylosing spondylitis
DIFFERENTIAL DIAGNOSIS Crystal-induced arthritis Gout Other disorders infectious arthritis periarticular tendenitis or bursitis Rare neoplastic synovitis pigmented villonodular synovitis neoplastic metastasis to juxta-articular bone
PHARMACOLOGICNON PHARMACOLOGIC SURGICAL INTERVENTION Considered as the CORNERSTONE in the Management of OA Considered as ADJUNCTS to Non-pharmacologic Management
NON PHARMACOLOGIC Psychosocial Interventions Patient Education Physical Modalities Thermal Modalities Exercise Supportive Devices Modifications in ADL Psychosocial Measures PHARMACOLOGIC Topical Agents Intra-articular Agents Oral (Systemic) Agents Symptom Modifiers Potential Disease Modifiers
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