1. Loyola-Provident-Cook County Family Medicine Residency
Osteoarthritis
Emanuel Diaz MD
Loyola-Provident-Cook County Family Medicine Residency

2. Objectives
To identify economic and physical impact of OA in a patient’s life.
To understand proposed etiology of OA and its pathophysiology.
To understand modalities and treatments available.
To get a glimpse of a new experimental modality undergoing research.

3. Demographics
Affects over 20 million individuals in the United States alone.
Estimated cost in medical care of billions.
Up to 65 billions if we add days of work lost.

4. Morbidity
The prevalence of osteoarthritis differs among different ethnic groups.
Equally common among men and women aged years.
More common in women after 55.
30% of affected individuals aged years.
More than 80% by their eighth decade of life.

5. Etiology Unknown Yet Risk Factors Increasing age Obesity Female sex
Trauma
Infection
Repetitive occupational trauma
Genetic factors
History of inflammatory arthritis
Neuromuscular disorder
Metabolic disorder

6. Pathophysiology Stages
Proteolytic breakdown of the cartilage matrix occurs by metalloproteinases.
Fibrillation and erosion of the articular cartilage.

7. Pathophysiology Stage 3 Chronic inflammatory response in the synovium.
Production of IL-1, TNF-a , metalloproteinases and NO.
More joint destruction.
Loss of architecture.
Bone overgrowth.

8. With this in mind.
It is important to understand that new evidence might show that OA is an inflammatory disease. Compared to what we once believed.

9. Symptoms Symptoms Physical Findings Pain Joint Stiffness
Morning Stiffnes s
Less than 30 minutes.
Instability (severe)
Malalignment with a bony enlargement .
Sometimes effusion
No erythema or warmth
Limitation of joint motion or muscle atrophy (severe)
Crepitus
Bouchard and or Heberden nodes. (Common in women)

10. OA http://www.poandpo.com/s208/osteoarthritis_5.jpg

12. Treatment AAOS and ACR Pharmacologic Surgical Arthroplasty (knee)
Acetaminophen
Max 4g/day
NSAIDS (inflammation present)
Lowest dose possible
Can add PPI or Misoprostol for GI disturbances prevention.
Cox-2 selective
Meloxicam, Piroxicam
Can use topicals.
Tramadol
For moderate to severe
Intraarticular
Steroids
Viscous supplement (Sinvisc, Hyalgan)
Narcotics if severe.
Arthroplasty (knee)
Can last up to 15 years
Osteotomy

13. Treatment AAOS and ARC
Mechanical
Knee taping
Good evidence

14. Treatment AAOS and ACR Education Lifestyle Stay informed
Follow Arthritis Foundation recommendations.
Loose weight (at least 5% of bodyweitgh) if overweight BMI >25

15. Treatment AAOS Mechanical CAM Bracing Not good evidence Acupuncture
inconclusive
Glucosamine and chondroitin
Not recommended in symptomatic patients.
Tai Chi
Needs more evidence
DMSO
Promising but needs more studies
Boron
Promising but needs more studies.
S-Adenosylmethionine- Antioxidant
Studies not randomized well or blinded.
Exercise :
Low impact aerobics Level 1 Grade A
Muscle strenghtening
Flexibility and ROM exercises. Level V Grade C

16. Treatment ACR
Nonpharmacologic therapy for patients with osteoarthritis Personalized social support through telephone contact Assistive devices for ambulation Appropriate footwear Lateral-wedged insoles (for genu varum) Bracing (recent article says no benefit***) Occupational therapy Bracing Joint protection and energy conservation Assistive devices for activities of daily living

17. Treatment ACR
Pharmacologic
Topical
Capsaicin Methylsalicylate

18. Experimental CAM
Yoga

19. Prognosis
The prognosis of osteoarthritis depends on joints involved and severity.
No proven disease/structure-modifying drugs for osteoarthritis currently exist.
Goal is symptoms relief.

20. References http://www.aaos.org/research/guidelines/OAKguideline.pdf
mgmt.asp?aud=mem