etiopathogenesis and clinical features of oa
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8/6/2019 Etiopathogenesis and Clinical Features of Oa
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ETIOPATHOGENESIS AND
CLINICAL FEATURES OF
OSTEOARTHRITIS
DR.S.M. Muhammad Thahir
MBBS., DNB(ORTHO).,
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OSTEOARTHRITIS
� Degenerative joint disease or ³wear and tear arthritis´.
� Progressive loss of cartilage with remodeling of
subchondral bone and progressive deformity of the joint.
� Cartilage destruction may be a result of a variety of
etiologies.
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RISK FACTORS
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CLASSIFICATIONS:
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Pathological Features
Progressive damage of Articular Cartilage.
Subchondral Bone Exposed
Subchondral sclerosis
Subchondral Cyst
Repair of Damage
(Osteophyte)
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PRIMARY OSTEOARTHRITIS
� Chronic degenerative disorder related to AGE
� Cartilage matrix has increased water content anddecreased proteoglycan
� This is different from the changes that occur with aging
cartilage dries up.
� Increased activity of proteinases compared to inhibitorsof proteinases.
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CELLULAR LEVEL
� Breakdown products of cartilage cause inflammatoryreaction of synovium
� Cytokines cause matrix degeneration. Where do they
come from?� chondrocytes
� Cycle of destruction starts .
� The body goes to work repairing the damage but therepair is inadequate resulting instead in growth of newbone along the side of the existing bone.
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� Bony proliferations at joint margins form, what are they
called?
� osteophytes
� Thought to be new bone formation in response to
degenerating cartilage.
� They cause joint motion restriction
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Overview of the process
Articular cartilagegets disrupted
Damage progressesdeeper tosubchondral bone.
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Left: View of normal elbow cartilage through an
arthroscope - white, glistening, smoothRight: severe elbow osteoarthritis - cartilage is lost
and the bone underneath is exposed
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Fragments of cartilagereleased into joint
Matrix degenerates
Eventually there iscomplete loss of cartilage
and complete loss of bone.
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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.
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CLINICAL FEATURES
�� Unlike other systemic forms of arthritis, Osteoarthritis
does not affect the other organs of the body.
� Symptoms vary greatly from patient to patient, but the
most common early symptom is pain in the affected joint
or joints.
� Pain in affected jointsSource:
Without cartilage, bones rub directly against eachother when the joint moves. This is what causes the painand inflammation.
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Other sources of Pain
Joint effusion andstretching of the jointcapsule
Torn menisci
Inflammation of periarticular bursae
Periarticular musclespasm
Psychological factors
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Pain in the Joint
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Slow in onset.
Pain may be worse in the morning and feelbetter with activity.
Vigorous activity may cause pain to flareup.
Occurs at rest with advanced disease.
May be referred eg hip pain referred to thethigh, groin, knee.
Pain may be aggravated with weather changes
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OTHER SYMPTOMS
� Stiffness , more pronounced in themorning and relieved by bending the Knee.
� Swelling of the Joint.
� Limitation in the motion of the Joint.
� Difficulty in Squatting , Sitting Leg crossedand going stairs
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Examination:
� Joint line tenderness.
� Joint line pain can
indicate tear of the lining
of the capsule or themeniscus.
� Bony enlargement of joint
� +/- effusion
� Crepitus
� Decreased range of motion
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� In the evaluation of joint line
pain, perform a varus or
valgus stress test.
� Apply stress across the joint,
place fingers directly over the
joint line to assess for pain, a
clunk may indicate a meniscal
tear , or crepitus may indicate
cartilage damage.
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� Have the patient liesupine with leg musclesrelaxed
� Compress thesuprapatellar pouch withyour thumb, palm, andindex finger.
� "Milk" downward and
laterally so that anyexcess fluid collects onthe medial side.
� Tap gently over thecollected fluid and
observe the effect on thelateral side
� A fullness on the lateralside indicates thepresence small kneeeffusion
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Deformity of the Joint in Advanced cases.
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