MC form of arthritis. Risk factor – ageing
- Loss of articular cartilage, subchondral osteosclerosis , osteophyte formation, remodelling
Pathology
- Genetic, environmental, occupational, congenital (slipped capital femoral epiphysis)
- Obesity – loading and cytokine release from adipose.
- Chondrocytes divide, increased degeneration of cartilage components (aggrecan/T3 collagen) > cartilage vulnerable to load bearing injury.
- Abnormal subchondral bone and fibrocartilage produced at margins > undergoes ossification
Clinical features
- Generalised nodal OA
- PIP/DIP , lateral deviation, herberdens (DIP) and bouchards (PIP)
- Genetic predisposition, female,
- Knee OA
- Bilateral/symmetrical, ant/medial compartments
- Posterior pain associated with baker cyst (popliteal)
- Asymmetric gait, varus , tendernessCPPD crystal deposits
- Hip OA
- Pain maximum at ant, may radiate to glutes
- Antalgic gait, restriction of internal rotation
- Spine OA
- Cervical and lumbar regions affected
- Early onset OA (<45Y)
- Joint trauma, JIA, metabolic/endocrine disease, neuropathic pain
- Erosive OA
- Mostly hand OA w/ prolonged symptoms, overt inflam
- Specific features – targeting PIP, subchondral erosion (XR), ankylosis, lack of OA elsewhere
Diagnosis
- XR, MRI (nerve root compression), FBC, serology, synovial aspiration
Treatment
- NSAIDS/analgesics
- Paracetamol, opiates, amyltriptyline, gabapentin
- Glucosamine
- Hyaluronic acid injection
- CS intra-articular injection
- Surgery – osteotomy