Osteoarthritis

• Osteoarthritis is the commonest condition affecting synovial joints
• No longer considered simple joint 'wear and tear'
• Change in cartilaginous matrix is probably important
• Primary OA is of unknown aetiology
• Secondary OA is the result of congenital, infective joint disorders or trauma
• Pathology characterised by:
  • Loss of hyaline cartilage
  • Subchondral bone sclerosis
  • Subchondral cyst formation
  • Osteophyte formation
• Several patterns of joint involvement recognised including:
  • Generalised nodular OA
  • Large joint osteoarthritis

Clinical features

• Joint pain - worse after exercise or at end of day
• Pain relieved by rest
• Limited early morning stiffness
• Limited stiffness after rest
• Bony joint swelling
• Few systemic features

Management

• Aims of treatment are to:
  • Reduce joint pain
  • Improve joint function
• In early stages pain can often be improved with simple analgesia
• Life style modification is also important
• NSAIDs can often help
• Intra-articular steroids can reduce symptoms
• If fails to improve with conservative measures surgery may be required
• Surgical options for degenerative joints are
  • Arthroscopic lavage and debridement
  • Osteotomy - alteration of joint alignment
  • Arthroplasty - replacement of diseased joint
  • Arthrodesis - fusion of disease joint

Bibliography

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Gupta K B, Duryea J, Weissmann B N. Radiographic evaluation of osteoarthritis. Radiol Clin North Am 2004; 42: 1-9.
Haq I, Murphy E, Dacre G. Osteoarthritis. Postgrad Med J 2003; 79: 377-383.
Hunter D J, Felson D T. Osteoarthritis. BMJ 2006; 332: 639-342
Scott D L. Advances in the medical management of rheumatoid arthritis. Hosp Med 2002: 63: 294-297.
Walker-Bone K, Javaid K, Arden N, Cooper C. Medical management of osteoarthritis. Br Med J 2000; 321: 936-940.