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IN THE NAME OF GOD

IN THE NAME OF GOD. OSTEOARTHRITIS. EPIDEMIOLOGY. EPIDEMIOLOGY. Most common type of arthritis A leading cause of disability in elderly Prevalence: - Aging - Obesity. EPIDEMIOLOGY. Common in: Knee, hand, spine… Spared: Wrist, elbow, shoulder, ankle Symptomatic knee OA:

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. OSTEOARTHRITIS

  3. EPIDEMIOLOGY

  4. EPIDEMIOLOGY • Most common type of arthritis • A leading cause of disability in elderly • Prevalence: - Aging - Obesity

  5. EPIDEMIOLOGY • Common in: • Knee, hand, spine… • Spared: • Wrist, elbow, shoulder, ankle • Symptomatic knee OA: • >30y 6% • >60y 12%

  6. EPIDEMIOLOGY • Symptomatic hand OA: • 10% of elderly • Hand OA >50% of person >70y • Correlate strikingly with age: - <40y Uncommon • Sex: • More common in women • Sex differences with age

  7. JOINT PROTECTORS

  8. PROTECTORS • Capsule and ligaments: • Limits excursion • Muscles and tendons: • Key protector • Function: - Appropriate power - Focal stress by: - Decelerate joint - Distribute across joint surface

  9. PROTECTORS • Mechanoreceptor: • In ligament, skin and tendon • Assume appropriate tension • Synovial fluid: • Friction • Lubricin: secreted by fibroblasts • Subchondral bone • Shock-absorber

  10. PROTECTORS • Cartilage: • A thin rim of tissue • Function: - Frictionless surface - Absorbing capacity • Component: - Chondrocyte - Matrix

  11. PROTECTORS • Chondrocyte: • Synthesize all element of matrix • Secret: - Growth factors - Cytokines (MMP…) • Matrix: • Type 2 collagen Tensile strength • Proteoglycans (aggrecan) Compressive strength

  12. PATHOPHYSIOLOGY

  13. PATHOPHYSIOLOGY • Joint failure • Initial step: failure of protective mechanisms • Pathologic change in all structures of joint • Hallmark: hyaline cartilage loss

  14. PATHOPHYSIOLOGY • Chondrocytes: • Metabolic activity, catabolic activity PG • Apoptosis • Chondrocytes and synovium: • IL1and TNFa PROTEINASE PROTEINASE ACTIVITY NO AGGRECAN SYNTHESIS Chondrocyte PG E2 MATRIX SYNTHESIS

  15. PATHOPHYSIOLOGY OA cartilage Aggrecan and Collagen Compressive and Tensile strength

  16. RISK FACTORS

  17. RISK FACTORS • AGE: • Most potent • Mechanisms: • Matrix synthesis Thin cartilage • Muscles: - Weaker - Less quickly response • Slow sensory impute • Ligament

  18. RISK FACTORS • FEMALE • GENETIC (OA in member): • Hand & Hip 50% • Knee 30% • Generalized Rare

  19. RISK FACTORS • JOINT: • Developmental • Fracture • AVN (Avascular necrosis) • Tear of ligament • Menisc • Malalignment • Bone density

  20. RISK FACTORS • OBESITY: • Knee in stance 3-6 times of weight • Knee OA and less for hip and hand OA • Women: Stronger (linear) • Symptom • Mechanisms: - Loading - Metabolic

  21. RISK FACTORS • REPEATED USE: • Farmers: Hip • Miners: Knee and Spine • Shipyards: Knee and Finger • Runners: Hip • Elite runner: Hip and Knee

  22. PATHOLOGY

  23. PATHOLOGY

  24. PATHOLOGY

  25. PATHOLOGY

  26. PATHOLOGY

  27. SOURSE OF PAIN

  28. SOURSE OF PAIN • Cartilage Aneural • Innervated structures: • Synovium, Ligaments, Capsule, Muscle, Bone( Sub.) NOT VISUALIZED BY X RAY X RAY CHANGES AND PAIN SEVERITY POORLY CORRELATION

  29. CLINICAL FEATURES

  30. CLINICAL FEATURES • Mechanical pain • Gelling pain • Night pain

  31. CLINICAL FEATURES • KNEE: • Buckling • Locking • Catching

  32. PHYSICAL EXAMINATION

  33. PHYSICAL EXAMINATION

  34. PHYSICAL EXAMINATION

  35. PHYSICAL EXAMINATION

  36. DIAGNOSIS • CLINICAL • No blood test routinely indicated • Synovial fluid

  37. DIAGNOSIS • X Ray: • Hand and hip pain • knee if: - Not typical symptom - Pain persists after effective treatment • Poorly correlation with pain severity • MRI: Not indicated - Meniscal tear in most patients

  38. RADIOLOGY

  39. HAND OA

  40. HAND OA

  41. HIP OA

  42. KNEE OA

  43. SPINE OA

  44. HALLUS RIGIDUS

  45. TREATMENT

  46. TREATMENT • NON PHARMACOTHERAPY • Mainstay of therapy • Weight loss: - Each Kg of weight: Load in knee 3-6 fold - Symptom of Knee & Hip OA

  47. TREATMENT • NON PHARMACOTHERAPY • Avoiding overload the joint - Knee & Hip Cane in opposite hand • Exercise: - Age - Disuse - Arthrogenous inhibition

  48. TREATMENT • NON PHARMACOTHERAPY • Degree of weakness correlate strongly with: - Severity of pain - Physical limitation • Correction of malalignment

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