DEGENERATIVE JOINT DISEASE Degenerative joint disease is chracterized by: 1. pain 2. stiffness 3. loss of mobility due to degeneration of synovial joints Among the most frequent and symptomatic medical problems in middle-aged and older people The most common cause of long therm disability in most populations It affects men and women of all etnic groups in all geographic locations.
Degenerative joint disease = osteoarthritis = = degenerative arthritis reffers to: 1. progressive loss of articular cartilage 2.accompanied by inadequate repair of articular cartilage 3. remodeling of subchondral bone 4. formation of osteophytes. It can affect any synovial joint The food, knee, hip, spine and hand joints are affected most often. The strong association exists between joint degeneration and age.
1. CARTILAGE CHANGES localised fibrillation or disruption of tehe most superficial layers of cartilage. the surface become roughened and irregular, fibrillation goes deeper, it reaches subchondral bone decrease of cartilage surface enzymatic degradation of the matrix-decrease of cartilage volume 2. BONE CHANGES alterations of the subchondral bone density: formation of cyst- like bone cavities increase of bone density - completely lost of cartilage 3. OSTEOPHYTES fibrous, cartilagineous and bony prominences develop around the periphery of the joints 4. SECONDARY CHANGES in the synovium, capsules, ligaments and musculs moderate inflammatory reaction
CLINICAL MANIFESTATIONS OF OA 1. painactivity associated, soon after the joint is used in more advanced stages the pain becomes constant and awakened patient from sleep 2. joint stiffness 3. loss of motion, grinding, osteophytes formation
VARIOUS SYMPTOMS FROM: occasional joint stiffness intermittent aching associated with activity permanent and severe restriction of motion with constant deep pain crippling deformity and joint instability
OSTEOARTHRITIS- spine OA affects weight-bearing joints(knee,hip), interphalangeal joints of the hands ( PIP-Bouchard ´s nodes,DIP joints- Heberden´s nodes) and feet Spine (spondylosis and spondylarthritis)
INVESTIGATION X-rays may show: –Loss of joint space resulting from cartilage damage –Osteophytosis(forrmation of new bone) –Altered bone contour –Subchondral sclerosis(increase bone density),cystic formation –Soft tissue swelling and periarticular calcification_
TREATMENT Primarily involves pain relief, initially with simple analgesics NSAIDs may be added if these are requied, Appropriate exercises Intra-articular steroid injections are useful if there are signs of inflammation Surgery –when the pain is intractable and severe limitation of mobility is present