Osteoarthritis (Oa) July 2010

OSTEOARTHRITIS ( OA )
A degenerative joint disease

Most common & most frequent of the
disabling joint disorder
Classified as primary (idiopathic) (of diseases) arising
from an unknown cause or secondary resulting from
previous joint injury or inflammatory dx
Begins in the 3rd decade of life
Peaks between the 5th & 6th
Direct correlation with age & the
degenerative process
PATHOPHYSIOLOGY OF OA
OA mostly affects cartilage
Cartilage is a tissue that covers the bone in a joint
Healthy cartilage allows bones to glide over each
other. It also helps absorb shock of movement
In OA, top layer of cartilage breaks down & wears
away
This allows bones under the cartilage to rub together
The rubbing causes pain, swelling & loss of motion of
the joint
Over time the joint loses its normal shape
Also bone spurs may grow on the edges of the joint
Bits of bone or cartilage can break off & float inside
the joint space, which causes more pain & damage
RISK FACTORS OF OA
OBESITY every lb gained add 3 lb of pressure on
knees, 6x on hips
age
Joint injury
Stress on joints fr certain jobs & sports
Genetics
Muscle weakness e.g. muscle surrounding the knee
Acromegaly or GH may have adverse effects on
bone & joints & can lead to OA
People with RA have higher chance of developing OA
SIGNS & SYMPTOMS OF OA

Stiffness in a joint after getting out of bed or
sitting for a long time
Last for less than 30 minutes and with
movement
Joint stiffness after periods of prolonged use
Swelling & tenderness on 1 or more joints
A crunching feeling or the sound of bone
rubbing on bone
Deterioration of coordination, posture & walking
Joint pain is usually less in the morning & worse
in the evening after a days activity
ASSESSMENT &
DIAGNOSIS
Difficult to diagnose
Physical assessment tender
enlarged
joints
- inflammation
X- ray progressive loss of cartilage
can be detected
GOALS OF MEDICAL
MANAGEMENT
OA treatment has 4 main goals:
Improve joint function
Keep a healthy body wt
Control pain
Achieve a healthy life style
CONSERVATIVE TREATMENT OF OA
Education
Use of heat
Weight reduction
Joint rest & avoidance of joint overuse
Orthotic devices
Exercises moderate & regular ex.
Strengthen muscle & bones
Massage
Occupational & physical therapy strengthen
muscle & improve flexibility
PHARMACOLOGIC TREATMENT OF
OA
Paracetamol
Oral NSAIDs same as in RA
Topical NSAIDs , capsaicin and methylsalicylate cream
Weak opioids & narcotic analgesics for severe pain
Intra-articular injection of corticosteroids
Intra-articular injection of hyaluronic acid
Glucosamine and/or chondroitin sulphate
SURGICAL TREATMENT OF OA
Arthroscopy
Osteotomy
Total joint replacement
TREATMENT OF OA
GLUCOSAMINE SULPHATE ( Viartril-S )
Popular treatment for OA - oral

Several studies demonstrated that glucosamine was comparable to
NSAIDs for knee OA
Other studies measuring changes in joint space narrowing
suggested an effect against articular cartilage loss
Real MOA is largely unknown
Thought to stimulate chondrocytes to make proteoglycans
Thought to inhibit cartilage catabolic enzymatic activity
Also improves the lubricant properties of synovial fluid
Safe
Not recommended in pt with seafood allergy glucasamine is
manufactured fr chitin found in shrimp, crabs & lobster shell or
produce synthetically
Sometimes combined with chondroitin sulphate more effective
Chondroitin sulphate is part of a protein that give cartilage elasticity
Glucosamine - continue
Side Effects
Upset stomach
Drowsiness
Insomnia
Headache
Skin reaction
Sun sensitivity
Loss of appetite
Nausea & vomiting
Flatulence
Constipation & diarrhoea
risk of bleeding
Glucosamine - continue
Drug Interaction
May risk & S/E of diuretics e.g. Lasix
May risk of bleeding when taken with aspirin,
anti-coagulant, anti platelet , NSAIDs
Chondroitin also may have anti- coagulant effect
HYALURONIC ACID ( Hyalgan )
In OA, the hyaluronic acid is decreased and compromised in

synovial fluid
HA acts as a shock absorber & lubricant in joints
HA is highly viscous, allowing the cartilage surfaces of the bones to
glide upon each other smoothly
Exogenous supplementation of intra-articular HA is thought to
support changes in synovial fluid
Injection of HA into joint or viscosupplementation is an effective
treatment for OA
Indicated for OA not responsive to non-pharmacologic measures &
to simple analgesia
Requires sterile technique, remove joint effusion if present prior to
injection
3 5 weekly injections recommended
Can be expensive
Pain relief usually by 8 12 wks can last up to 6 10 months
Treatment can be repeated every 6 months prn
INJECTION HYALURONIC ACID

CONT.
Joints Usually Injected
Shoulder
Elbow
Hip
Knee
Hand
Wrist
Foot
Possible S/E
Swelling
Pain
Contraindication
Joint infection / skin infection at injection site
Eggs / poultry allergy
CORTICOSTEROID INJECTIONS
Allow to deliver a high dose of medication to the problem

area (direct to joint)
Suppress inflammation - erythema, swelling, heat,
tenderness
Help preserve joint structure & function
Avoid the need for oral steroids which have greater S/E
Not expensive
Significant improvement after 1 week of inj effect lasting for
3 4 wks to 6 months
Allow 4 6 weeks between injections
In severe OA joints can be injected up to 3 4 times per
year
Avoid injecting several large joints at the same time
E.g. Triamcinolone, methyprednisolone

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OSTEOARTHRITIS ( OA )

A degenerative joint disease

SIGNS & SYMPTOMS OF OA

Popular treatment for OA - oral

HYALURONIC ACID ( Hyalgan )

In OA, the hyaluronic acid is decreased and compromised in

INJECTION HYALURONIC ACID

Joints Usually Injected

Allow to deliver a high dose of medication to the problem

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