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Osteoarthritis, Question: What are the hallmark signs of osteoarthritis? -…
Osteoarthritis
Pathophysiology
Genetic factors
- Rare mutations in collagen types II, IX, or XI can cause premature OA
- Mutations in GDF-5 are thought to predispose to OA due to altered joint shape
- Multiple genes are needed for a more substantial OA risk
(Loeser, 2021)
Risk Factors
- Joint abnormalities
- Obesity
- Female Sex
- Age
- Joint injury
Inflammatory mediators may play a role in the pathogenesis of OA as potential drivers of joint tissue destruction
The destruction of joint tissues in OA is mediated by a variety of proteases including several MMPs, cysteine proteinases and serine proteinases.
Presentation
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Physical Examination
- Boney swelling
- Joint deformity
- Limitation of active & passive movement
- Instability (knee)
Seen most commonly in knees, hips, finger interphalangeal joints, first CMC joints, first MTP joints, and apophyseal (facet) joints of the lower cervical and lower lumbar spine
(Doeherty & Abhishek, 2023)
Testing
Radiography allows for detection of characteristic features of OA, include marginal osteophytes, localized joint space narrowing, subchondral sclerosis, and cysts.
Ultrasonography can identify OA-associated structural changes and is useful for detecting features such as synovial inflammation, effusion and osteophytosis.
Synovial fluid from OA joints is usually noninflammatory, predominately mononuclear cells.
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Differential diagnosis to consider: Rheumatoid arthritis, psoriatic arthritis, crystalline arthritis, hemochromatosis, infectious arthritis, soft tissue abnormalities.
Clinical Diagnosis: 1) Persistent usage-related joint pain in one or few joints, 2) Age >45 y.o. 3) morning stiffness greater than 30 min.
Epidemiologic concepts
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OA is the most common forms of arthritis, representing 62% of all arthritic conditions in 2017-2018.
Substantial morbidity associated with OA, including disability and reduced quality of life.
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Globally, 595 million people are affected by OA.
The knee is the most commonly reported site of OA, with 368 million prevalent cases in 2020. Hip OA is less common than knee or hand OA.
Knee OA in the US is similar to that of Europe, with lower rates reported in southern Asia.
Pharmacotherapeutics
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Duloxetine
For patients with OA in multiple joints and concomitant comorbidities that may contradict oral NSAIDs
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Acetaminophen is no longer considered the first line analgesic for the treatment of knee and hip OA by clinical guidelines.
Treatments for OA targets pain, none have been proven to alter the structural progression of the disease.
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Medical resources
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Exercise programs, chair exercises, ROM examples. Many offices have these as pamphlets to give to patients,
Disease Management
Lifestyle Changes
Weight loss
Loss of at least 10% body weight has been associated with a 50% reduction in pain scores in patients who are overweight with knee OA after 18 months.
Treatment Plan
Goals are to minimize pain, optimize function, and modify joint damage process. Treatment plans are individualized based on patient need and severity of OA.
When to Refer?
Surgical treatment is dominated by total joint replacement, which is highly effective in patients with advanced knee and hip OA when conservative therapies have failed to provide adequate pain relief.
Preventing complications
Caution with pharmacologic therapy needs to occur. Patients are taking NSAIDS and Tylenol regularly.
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Psychosocial
Health Promotion
Patients should be encouraged to participate in self-management of their OA. Providers can empower them to manage their weight, exercise, and have a positive outlook on their disease.
Studies have shown that cognitive behavioral therapy can be beneficial in patients struggling with chronic pain related to OA.
Cultural
All cultures express pain differently. It is important to take this into consideration when we evaluate pt's for OA.
Providers need to understand the impact that disability and/or surgery will have on patients based on their culture.
The understanding and acceptance of their OA can have an affect on the support the patient receives from their family/friends.
Obesity and an unhealthy diet is more prevalent in certain countries (the U.S.), and this can create difficulties in patients losing weight or incorporating exercise.
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