Osteoarthiritis Flashcards
OA Signs and symptoms?
The main symptom is pain, causing loss of ability and often stiffness. The pain is typically made worse by prolonged activity and relieved by rest. Stiffness is most common in the morning, and typically lasts less than thirty minutes after beginning daily activities, but may return after periods of inactivity. Osteoarthritis can cause a crackling noise (called “crepitus”) when the affected joint is moved, especially shoulder and knee joint. A person may also complain of joint locking and joint instability. These symptoms would affect their daily activities due to pain and stiffness.[14] Some people report increased pain associated with cold temperature, high humidity, or a drop in barometric pressure, but studies have had mixed results.[15]
Osteoarthritis commonly affects the hands, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As osteoarthritis progresses, movement patterns (such as gait), are typically affected.[16] Osteoarthritis is the most common cause of a joint effusion of the knee.[17]
In smaller joints, such as at the fingers, hard bony enlargements, called Heberden’s nodes (on the distal interphalangeal joints) or Bouchard’s nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. Osteoarthritis of the toes may be a factor causing formation of bunions,[18] rendering them red or swollen.
OA Risk factors
Damage from mechanical stress with insufficient self repair by joints is believed to be the primary cause of osteoarthritis.[19] Sources of this stress may include misalignments of bones caused by congenital or pathogenic causes; mechanical injury; excess body weight; loss of strength in the muscles supporting a joint; and impairment of peripheral nerves, leading to sudden or uncoordinated movements.[19] However exercise, including running in the absence of injury, has not been found to increase the risk of knee osteoarthritis.[20] Nor has cracking one’s knuckles been found to play a role.[21]
Occupational
See also: Occupational disease and Occupational injury
Increased risk of developing knee and hip osteoarthritis was found among those who work with manual handling (e.g. lifting), have physically demanding work, walk at work, and have climbing tasks at work (e.g. climb stairs or ladders).[6] With hip osteoarthritis in particular, increased risk of development over time was found among those who work in bent or twisted positions.[6] For knee osteoarthritis in particular, increased risk was found among those who work in a kneeling or squatting position, experience heavy lifting in combination with a kneeling or squatting posture, and work standing up.[6] Women and men have similar occupational risks for the development of osteoarthritis.[6]
OA secondary Risk factors
Secondary
Alkaptonuria
Congenital disorders of joints
Diabetes doubles the risk of having a joint replacement due to osteoarthritis and people with diabetes have joint replacements at a younger age than those without diabetes.[31]
Ehlers-Danlos Syndrome
Hemochromatosis and Wilson’s disease
Inflammatory diseases (such as Perthes’ disease), (Lyme disease), and all chronic forms of arthritis (e.g., costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
Injury to joints or ligaments (such as the ACL), as a result of an accident or orthopedic operations.
Ligamentous deterioration or instability may be a factor.
Marfan syndrome
Obesity
Joint infection
OA Pathophysiology
While osteoarthritis is a degenerative joint disease that may cause gross cartilage loss and morphological damage to other joint tissues, more subtle biochemical changes occur in the earliest stages of osteoarthritis progression.
Other structures within the joint can also be affected.[41] The ligaments within the joint become thickened and fibrotic and the menisci can become damaged and wear away.[42] Menisci can be completely absent by the time a person undergoes a joint replacement. New bone outgrowths, called “spurs” or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces in the absence of the menisci. The subchondral bone volume increases and becomes less mineralized (hypomineralization).[43] All these changes can cause problems functioning. The pain in an osteoarthritic joint has been related to thickened synovium[44] and subchondral bone lesions.[45]
OA classification?
Osteoarthritis can be classified into either primary or secondary depending on whether or not there is an identifiable underlying cause.
Both primary generalized nodal osteoarthritis and erosive osteoarthritis (EOA, also called inflammatory osteoarthritis) are sub-sets of primary osteoarthritis. EOA is a much less common, and more aggressive inflammatory form of osteoarthritis which often affects the distal interphalangeal joints of the hand and has characteristic articular erosive changes on x-ray.[56]
Osteoarthritis can be classified by the joint affected:
Hand: Trapeziometacarpal osteoarthritis Wrist (wrist osteoarthritis) Vertebral column (spondylosis) Facet joint arthrosis Hip osteoarthritis Knee osteoarthritis
OA management
Lifestyle modification (such as weight loss and exercise) and analgesics are the mainstays of treatment. Acetaminophen (also known as paracetamol) is recommended first line with NSAIDs being used as add on therapy only if pain relief is not sufficient.[58] This is due to the relative greater safety of acetaminophen.[58]
Lifestyle changes
For overweight people, weight loss may be an important factor.[59] Patient education has been shown to be helpful in the self-management of arthritis.[59] It decreases pain, improves function, reduces stiffness and fatigue, and reduces medical usage.[59] Patient education can provide on average 20% more pain relief when compared to NSAIDs alone in patients with hip osteoarthritis.[59]
Physical measures
Moderate exercise may be beneficial with respect to pain and function in those with osteoarthritis of the knee and hip.[60][61][62] These exercises should occur at least three times per week.[63] While some evidence supports certain physical therapies, evidence for a combined program is limited.[64] Providing clear advice, making exercises enjoyable, and reassuring people about the importance of doing exercises may lead to greater benefit and more participation.[62] There is not enough evidence to determine the effectiveness of massage therapy.[65] The evidence for manual therapy is inconclusive.[66] Functional, gait, and balance training have been recommended to address impairments of position sense, balance, and strength in individuals with lower extremity arthritis as these can contribute to a higher rate of falls in older individuals.[67] For people with hand osteoarthritis, exercises may provide small benefits for improving hand function, reducing pain, and relieving finger joint stiffness.[68]
Lateral wedge insoles and neutral insoles do not appear to be useful in osteoarthritis of the knee.Knee braces may help[72] but their usefulness has also been disputed.[71] For pain management heat can be used to relieve stiffness, and cold can relieve muscle spasms and pain.[73] Among people with hip and knee osteoarthritis, exercise in water may reduce pain and disability, and increase quality of life in the short term.[74] Also therapeutic exercise programs such as aerobics and walking reduce pain and improve physical functioning for up to 6 months after the end of the program for people with knee osteoarthritis.
OA Treatment
There are several NSAIDs available for topical use, including diclofenac. A Cochrane review from 2016 concluded that reasonably reliable evidence is available only for use of topical diclofenac and ketoprofen in people aged over 40 years with painful knee arthritis.[91] Transdermal opioid pain medications are not typically recommended in the treatment of osteoarthritis.[88] The use of topical capsaicin to treat osteoarthritis is controversial, as some reviews found benefit[92][93] while others did not.[94]
Joint injections
Joint injection of glucocorticoids (such as hydrocortisone) leads to short term pain relief that may last between a few weeks and a few months.[95] Injections of hyaluronic acid have not produced improvement compared to placebo for knee arthritis,[96][97] but did increase risk of further pain.[96] In ankle osteoarthritis, evidence is unclear.[98] The effectiveness of injections of platelet-rich plasma is unclear; there are suggestions that such injections improve function but not pain, and are associated with increased risk.[vague][99][100]
A 2015 Cochrane review found that intra-articular corticosteroid injections of the knee did not benefit quality of life and had no effect on knee joint space; clinical effects one to six weeks after injection could not be determined clearly due to poor study quality.[101] Another 2015 study reported negative effects of intra-articular corticosteroid injections at higher doses,[102] and a 2017 trial showed reduction in cartilage thickness with intra-articular triamcinolone every 12 weeks for 2 years compared to placebo.[103] A 2018 study found that intra-articular triamcinolone is associated with an increase in intraocular pressure.[104]
Surgery
If the impact of symptoms of osteoarthritis on quality of life is significant and more conservative management is ineffective, joint replacement surgery or resurfacing may be recommended. Evidence supports joint replacement for both knees and hips as it is both clinically effective,[105][106] and cost-effective.[107][108] Surgery to transfer articular cartilage from a non-weight-bearing area to the damaged area is one possible procedure that has some success, but there are problems getting the transferred cartilage to integrate well with the existing cartilage at the transfer site.[109]
Osteotomy may be useful in people with knee osteoarthritis, but has not been well studied and it is unclear whether it is more effective than non-surgical treatments or other types of surgery.[110] Arthroscopic surgery is largely not recommended, as it does not improve outcomes in knee osteoarthritis,[111][112] and may result in harm.[113]
For people who have shoulder osteoarthritis and do not respond to pharmaceutical approaches, surgical options include a shoulder hemiarthroplasty (replacing a part of the joint), and total shoulder arthroplasty (replacing the joint).[114]
