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 2nd 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
- 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.
Reference:
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