Osteoarthritis

 

 

 

Epidemiology

-         Most common form of joint disease

-         Disease prevalence is increased with age

 

Risk Factor

-         Obesity

o       Increased body mass associated at the knee

§         A weight loss of 5% reduce the risk by upto 50% of developing symptomatic knee

-         Occupation, sports and trauma

o       Perform repetitive activities,

o       Dock worker, basket weavers, jackhammer operator

§         Higher incidence of hand

-         Trauma

o       to the joint, loss of ligament integrity

-         Genetic factor

o       Heberden’s nodes are ten times more prevalent in women than men

 

Signs and symptoms

-         Depends on the duration of disease, joints affected, and severity of joint involvement

-         Localized deep aching pain

-         Weather change also seem to aggravate the pain

-         The limitation of motion develops as the disease progresses is related to the loss of articular surfaces, muscle spasms, capsular contracture and mechanical blockage 2^nd to osteophytosis

Lab finding

-         no specific clinical lab abnormalities occur in primary disease

-         Erythrocyte sedimentation rate may be elevated

-         Rheumatoid factor is negative

-         Synovial fluid demonstrates a mild leukocytosis with predominate mononuclear cell

-         Radiologic evaluation is absolutely necessary

-         With progression of degenerative changes in cartilage, the joint space may begin to narrow

-         Later, subluxation and deformity sometimes occur

-         Technetium-99m imaging also been used

-         Weight bearing radiographs at the knee provide better definition of the joint space

-         Computed tomography, magnetic resonance imaging, ultrasonographic techniques are also used

o       Limited usefulness

Diagnosis

-         evaluation of patient’s history, clinical examination of the affected joints, Radiologic findings

Nonpharmacologic therapy

-         educate the patient about the extend, degree of involvement, prognosis, and management approach

-         www.arthritis.org

-         diet

o       the excess weight can contribute not only the progression of the disease but also to the contraction of the muscles that span and stabilized the joint

o       glucosamine; a basic constituent of cartilage glycosaminoglycans

§         stimulates cartilage

-         exercise

o       isometric techniques to strengthen the muscles

§         improve joint function

o       fitness walking

-         surgery

o       for patients with severe disease

§         substantial pain

§         marked functional disabilities

o       if osteophytes are large, removal may increase joint range of motion

Pharmacologic therapy

-         Analgesic

o       Tylenol

§         325-650 mg 4 times daily, max dose 4 gram daily

o       Asprin

§         A dose of greater than 3.6 gram per day needed

§         Low albumin concentrations, increasing age, highly protein bound drugs can increase the toxic effects from salicylates.

§         2 type of reaction

·        1.  bronchospasm, vasomotor rhinitis, nasal polyp, laryngeal edema

·        2.  urticaria, angioedema

§         decreased platelet aggregation

o       capsaicin

§         extract of red peppers

§         depletion of substance P

§         2-4 times daily

§         rubbing around the joint

o       tramadol, propoxyphene, codeine

§         reserved for patient who have failed single, multiple analgesic, topical or NSAIDs

§         severe pain, for the shortest duration possible

-         Nonsteroidal anti-inflammatory drugs

o       Analgesic effect at lower doses, antiinflammatory activity at higher doses

o       Reduction of prostaglandin biosynthesis by inhibit COX1 and COX2

o       Vioxx, Celebrex

§         COX2 inhibitor

§         Better in gastrointestinal

-         Corticosteroids

o       SYSTEMIC THERAPY OS NOT RECOMMENDED

§         INTRA-ARTICULAR CORTICOSTEROIDS (IAC)

§         Helpful in patients with knee effusions at interval 4-6 month for any given joint, not exceed 3-4 per year

-         Hyaluronate injection

o       Contain hyaluronic acid

o       Assist in the reconstitution of the Synovial fluid, improving joint function

o       Require once weekly administration for 3 or 5 consecutive weeks.