1. OSTEOARTHRITIS
(OA)
Rogelio A Balagat MD
ASMPH

2. Assignment:
Age
Weight & height (BMI)
Joint pain (VAS)
Joint deformity

3. Definition of OA
Joint failure
failure of protective mechanisms
cartilage loss
subchondral bone changes
osteophytes
capsule stretching
mild synovitis
periarticular muscle weakness

4. -OA +OA WEIGHT-BEARING FAILURE OF PROTECTIVE MECHANISMS JOINT INJURY
JOINT REPAIR
-OA
+OA

5. Cartilage Avascular Aneural Load-bearing Low friction
Main joint protector
Cartilage
Avascular
Aneural
Load-bearing
Low friction

6. Joint protectors Joint fluid lubrication Muscle-skin sensory afferent
nerve mechanoreceptors
Muscle-tendon co-contraction
Subchondral bone shock-absorption

8. CATABOLISM
SYNTHESIS
CHONDROCYTE

11. ↑AGE
↑WEIGHT
PREVIOUS DAMAGE

13. accumulated microtrauma lower limb malalignment genetic factors
PRIMARY OA
aging bone & cartilage
mechanical factors
accumulated microtrauma
lower limb malalignment
genetic factors

14. congenital, genetic, developmental disorders
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
Cushing’s disease
gout/pseudogout

15. Chronic
>40, F>M, ↑weight
Non-inflammatory
DIP, CMC1, Knee, Hip
Use-related pain
onset of movement
after activity
improved with rest

16. KNEE OA HAND OA Bouchard’s nodes (PIP) Heberden’s nodes (DIP)
“squared-off” base of thumb
malalignment
swelling
crepitus

17. HIP OA pain in groin or inner thigh
antalgic gait, limited/loss of flexion,
extension, rotation
predisposing conditions
congenital hip dysplasia,
avascular necrosis

18. SPINE OA disc/vertebral bodies (spondylosis) paraspinal pain, spasm
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

19. 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

20. Radiography
Bone formation
(-) bone erosion

21. DIFFERENTIAL DIAGNOSIS
Rheumatoid Arthritis
Monoarticular
Polyarticular
Spondyloarthropathies
Psoriatic arthritis
Reactive arthritis
Inflammatory bowel disease
Ankylosing spondylitis

22. 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

23. Management PHARMACOLOGIC NON PHARMACOLOGIC ADJUNCTS to
Considered as
ADJUNCTS to
Non-pharmacologic
Management
Considered as the
CORNERSTONE in the
Management of OA
SURGICAL
INTERVENTION

24. PHARMACOLOGIC NON PHARMACOLOGIC Psychosocial Interventions
Topical Agents
Patient Education
Intra-articular Agents
Psychosocial Measures
Oral (Systemic) Agents
Physical Modalities
Symptom Modifiers
Thermal Modalities
Potential Disease Modifiers
Exercise
Supportive Devices
Modifications in ADL

25. Thanks