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Osteoarthritis: OA

Osteoarthritis: OA. Janet Pope MD MPH FRCPC. Goals. Identify the most common joints affected in OA Differentiate OA from RA Describe the most common treatments for OA including non-pharmological. Case: Diane. This is a 62 year old woman with 3 kids

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Osteoarthritis: OA

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  1. Osteoarthritis: OA Janet Pope MD MPH FRCPC

  2. Goals • Identify the most common joints affected in OA • Differentiate OA from RA • Describe the most common treatments for OA including non-pharmological

  3. Case: Diane • This is a 62 year old woman with 3 kids • She has had on-going bilateral knee pain for the past 3 years • It flares on and off • It tends to be worse when she is active • At times she has difficulty sleeping because of knee pain

  4. Diane has made some positive moves • She manages to walk every morning when her knees are “feeling good” • She lost 28 lbs and has kept it off for the last 5 years • She is otherwise healthy and takes no other medications with the exception of occasional acetaminophen for her knees

  5. OA Knee Xrays • Often we order weight bearing views • AP knees standing • Joint space narrowing • Osteophytes, sclerosis, bony cysts • Joint space narrowing may be assymetrical • Malalignment (ex valgus or varus deformity)

  6. Here are Diane’s Hands

  7. Diagnosis • Diane has osteoarthritis • OA / degenerative arthritis • Osteoarthritis is the most common form of chronic arthritis

  8. Osteoarthritis: Definition • A joint disease characterized by: • Pain that typically worsens with weight bearing and activity and improves with rest • Morning stiffness and gelling of the involved joint after periods of inactivity • Tenderness on palpation, bony enlargement, crepitus on motion, and/or limitation of joint motion • There may be joint swelling and heat ACR Recommendations: Arthritis Rheum 2000; 43(9):1905-15.

  9. Osteoarthritis Facts • OA affects 3,000,000 (1 in 10) Canadians1 • OA is associated with significant costs:2 • Direct (e.g., drugs, healthcare resource use) • Indirect (e.g., lost employment time, costs of informal caregiving) • Under treatment leads to significant pain and loss of quality of life 1 & 2 - Arthritis Society of Canada: www.arthritis.ca

  10. Osteoarthritis: Clinical Characteristics • OA is common • It is not always symptomatic • Usually insidious onset • Usually less than a half hour of am joint stiffness • Younger age Men>women • Older age Women>men • Worse with activity • Better with rest

  11. Bony Enlargement PIP bony enlargement Bouchard’s nodes DIP bony enlargement Heberden’s nodes

  12. Distribution of Joints • Hands: • DIP, PIP, 1st CMC joints • Hip • Knee • Feet: • First MTP • Spine • Cervical, lumbar

  13. RA OA

  14. First CMC OA –squaring at base of thumb

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