Osteoarthritis

Osteoarthritis (OA) also known as degenerative arthritis or degenerative joint disease or a disease of the joints, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone . Symptoms may include joint pain, stiffness, locking, and sometimes an effusion. A variety of hereditary causes, development, metabolic and mechanical deficits may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of the decrease of the secondary movement pain, regional muscles may atrophy, and ligaments can become lax.

Treatment usually involves a combination of exercise, lifestyle modification, and analgesics. If the pain becomes debilitating, joint replacement surgery can be used to improve the quality of life. Osteoarthritis is the most common form of arthritis, and the leading cause of chronic disability in the United States. It affects about 1.9 million people in Australia 8 million people in the United Kingdom and nearly 27 million people in the United States.

MRI of osteoarthritis of the knee, with a characteristic narrowing of the joint space.

ICD-10 M15-M19, M47

ICD-9715

OMIM 165720

DiseasesDB 9313

MedlinePlus 000423

eMedicine med/1682 orthoped/427 pmr/93 radio/492

MeSH D010003

Signs and symptoms

The Bouchard's nodes and Heberden's nodes may form in osteoarthritis

The main symptom is pain, causing loss of ability and often stiffness. "Pain" is generally described as a sharp pain or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called "crackling") when the affected joint is moved or touched and people may experience muscle spasm and contractions in the tendons. Sometimes the joints may also be filled with fluid. [6] Some people report increased pain associated with cold, high humidity and / or a decrease in barometric pressure, but studies have had mixed results.

OA commonly affects the hands, feet, spine, and large weight-bearing joints such as hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints are larger, are stiff and painful, and usually feel better to use gentle but worse with excessive or prolonged use, thus distinguishing it from rheumatoid arthritis.

In small joints such as the fingers, hard bony enlargements, called Heberden nodes (on IPD) and / or Bouchard's nodes (on the proximal interphalangeal joints), may form, and if they are not necessarily painful, they limit movement of the fingers significantly. OA at the toes leads to the formation of onions, making them red or swollen. Some people notice these physical changes before they suffer no pain.

Osteoarthritis is the most common knee joint effusion cause.

Causes

Damage caused by mechanical stress with insufficient self repair joints is considered the main cause of osteoarthritis. Sources of this stress may include: inadequacy of bones caused by congenital or pathogenic causes; mechanical injury, excess weight, loss of strength in the muscles supporting a gasket, and impairment of peripheral nerves, leading to stroke or uncoordinated movements.However exercise, including running in the absence of injury, has not been found to increase risk.Nor a cracking his joints were found to play a role.

Primary

Primary osteoarthritis of the left knee. Note the osteophytes, narrowing of the joint space (arrow), and the density of subchondral bone increased (arrow).

A number of studies have shown that there is a greater prevalence of the disease in siblings and especially identical twins, indicating a hereditary basis. Although only one factor is generally not sufficient to cause the disease, about half of the variation of the sensitivity was attributed to genetic factors.

As our human ancestors evolved into bipeds start, changes in the pelvis, hip and spine increased the risk of genetic variations that increase the risk osteoarthritis.Additionally probably was not chosen because usually against the problems occur after the success of reproduction.

The development of osteoarthritis is correlated with a history of joint injury and obesity, in particular as regards the knees.Since correlation with obesity was observed not only for the knees, but also for non-joint bearing and loss of body fat is more closely related to relieve the symptoms of loss of body weight, it was suggested that there could be a metabolic link to body fat, as opposed to just a mechanical loading.

Changes in levels of sex hormones may play a role in the development of osteoarthritis as it is more common in postmenopausal women than men in the same study found age.A mouse natural female hormones to be protection while injections of the male hormone dihydrotestosterone reduced protection.

Secondary

This type of OA is caused by other factors, but the resulting pathology is the same as for primary osteoarthritis:

AKU

Congenital abnormalities of joints

Diabetes

Ehlers-Danlos

Hemochromatosis and Wilson's disease

Inflammatory diseases (such as Perthes disease), (Lyme disease), and all forms of chronic arthritis (e.g. costochondritis, gout and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage degenerates at a faster pace.

Injuries to joints or ligaments (such as ACL), following an accident or orthopedic operations.

Ligament deterioration or instability may be a factor.

Marfan syndrome

Obesity

Septic arthritis (joint infections)

Pathophysiology

Primary OA is a chronic degenerative disease related to, but not caused by aging, as there are people well into their nineties who have no clinical or functional signs of the disease. As a person ages, the water content of the cartilage decreases better source needed] as a result of a reduced proteoglycan content, thus causing the cartilage to be less elastic. The water content of healthy cartilage is finely balanced by a force of water swelling and compression chasing draw water in. collagen fibers carry the force of compression pressure, while the Gibbs-Donnan effect and cartilage proteoglycan create a osmotic pressure which tends to draw water in. However during the development of osteoarthritis, there is an increase in the water content of the cartilage.

This increase occurs because while there is an overall loss of proteoglycans, it is offset by a loss of collagen.Without The protective effects of the proteoglycans, the collagen fibers of the cartilage can become susceptible to degradation and thus exacerbate the degeneration. Inflammation of the surrounding joint capsule can also occur, though often mild (compared to what happens in rheumatoid arthritis). This can happen as breakdown products of cartilage are released into the synovial space, and the cells lining the joint attempt to remove them. New bone outgrowths, called "spurs" or osteophytes, can form on the margins of the joints, possibly in an attempt to improve the congruence of the articular cartilage surfaces. These changes in the bone, as well as inflammation, can be both painful and debilitating.

Diagnosis

The diagnosis is made with reasonable certainty based on history and clinical examination. X-rays can confirm the diagnosis. The typical changes seen on X-ray include: joint space narrowing of the space, subchondral sclerosis (increased bone formation around the joint), the formation of subchondral cysts, osteophytes and movies. level may not correlate with the results of the physical examination or with the degree of pain. Usually other imaging techniques are not needed to diagnose clinically OA.

In 1990, the American College of Rheumatology, using data from a multi-center study, developed a set of criteria for the diagnosis of hand osteoarthritis based on hard tissue enlargement and swelling of certain joints. [33] These criteria were considered 92% sensitive and 98% specific for hand OA compared to other entities such as rheumatoid arthritis and spondyloarthritis.

Related pathologies whose name may be confused with osteoarthritis include pseudo-arthrosis. It is derived from Greek words nickname, which means "false", and arthrosis, meaning "common." Results diagnostic radiography in the diagnosis of a fracture in a joint, which should not be confused with osteoarthritis which is a degenerative disease affecting a high incidence of distal phalangeal joints of female patients. One aspect of the ivory polite can also develop on the bones of the joints affected, reflecting a change called éburnation.

Classification

OA can be classified as primary or secondary depending on whether or not there is an identifiable underlying cause.

For both the nodal and generalized osteoarthritis erosive osteoarthritis (EOA, also called inflammatory osteoarthritis) are subsets of primary osteoarthritis. EOA is a much less common inflammatory form, more aggressive Osteoarthritis commonly affects the distal interphalangeal joints of the hand and erosive joint changes characteristic x-ray.

Management

lifestyle modification (such as weight loss and exercise) and analgesics are the mainstay of treatment. Acetaminophen (also known as paracetamol) is recommended first line with NSAIDs used as add on treatment only if the pain is not sufficient.This is due to the greater relative safety of acetaminophen.

modification of lifestyle

For overweight people, weight loss may be an important factor. Patient education has been shown to be useful in self-management of arthritis. It reduces pain, improves function, reduces stiffness and fatigue, and reduces medical consumption. [38] Patient education can provide 20% more than average relief of pain compared to NSAIDs alone in patients with osteoarthritis of the hip.

Physical measurements

Moderate exercise is beneficial with respect to pain and function in people osteoathritis knee and perhaps hip.While evidence supports some evidence of physical therapy for a combined program limited.There is not enough evidence to determining the effectiveness of massage therapy.

The use of orthotics (which include splints, braces or insoles) were studied. Lateral wedge insoles do not seem to be useful in osteoarthritis of the knee. knee may be helpful.

Evidence of manual therapy is not conclusive. Functional, gait, and balance has been recommended for treatment of impairment of position sense, balance and strength in individuals with arthritis of the lower end of these can contribute to falls higher among the elderly.

Drug

Acetaminophen is the analgesic first-line treatment for mild to moderate symptoms OA.For efficiency is similar to anti-inflammatory drugs (NSAIDs), although for more severe symptoms NSAIDs may be more effective. NSAIDs such as naproxen, while effective in severe cases are associated with more serious side effects such as gastrointestinal bleeding.Another class of NSAIDs, COX-2 selective inhibitors such as celecoxib () are also effective for NSAIDs with lower rates of gastrointestinal side effects, but higher rates of cardiovascular diseases such as myocardial infarction. [48] ??They are also much more costly. Oral steroids are not recommended in the treatment of OA because of their modest benefit and high rate of adverse effects.

There are several NSAIDs available for topical use including diclofenac. They have fewer systemic side effects and at least one Cochrane review concluded that therapeutic effect.A opioid analgesics such as morphine and fentanyl reduce pain, but this advantage is offset by the common side effects and therefore should not be systematically used. [50] Capsaicin is controversial with some comments find advantage and others do not.

Injection of glucocorticoids (such as hydrocortisone) leads to relieve short-term pain that can last from several weeks to several months. Intra-articular injections of hyaluronic acid have not been found to lead to a significant improvement. Injected hyaluronic were associated with significant acid damage. However another study on hyaluronic acid injections said efficacy on pain and function, and no adverse effects compared with saline injections.

Surgery

If the disability is important and conservative treatment is ineffective, surgery or resurfacing joint replacement may be recommended. Evidence supports joint replacement for knees and hips. [56] For the knee, it improves both pain and function. [57] Arthroscopic surgery for osteoarthritis of the knee but was not considered better than placebo in relieving symptoms.

Alternative medicine

Dietary supplements

Many dietary supplements are sold as treatments for osteoarthritis and some of them have been found to be effective. Phytodolor, SAMe, and SKI 306x (a Chinese herbal mixture) can be effective in improving pain, and there is some evidence to support the use of cat's claw as an anti-inflammatory.There is proof of principle to support unsaponifiable avocado / soybean extract Boswellia serrata (frankincense), MSM and rose hip.

The effectiveness of glucosamine is controversial. Most recent comments have shown that it is better than placebo at or only slightly. A difference may exist between glucosamine sulfate and glucosamine hydrochloride, glucosamine sulfate showing a benefit and glucosamine hydrochloride not.The Osteoarthritis Research Society International recommends that glucosamine be discontinued if no effect is observed after six months ] and the National Institute of Clinical Excellence recommends its use.Despite more difficult to determine the effectiveness of glucosamine, it remains a viable treatment option.

There is little evidence to support benefits for some supplements, including: preparations Ayurvedic herbal with brand names and Eazmov Articulin F, collagen, devil's claw, Duhuo Jisheng Wan (a preparation Chinese plants), liver oil, fish, ginger, preparation based Gitadyl plants, glucosamine, hyaluronic acid, omega-3 fatty acids, the product brand Reumalax, nettle, turmeric, vitamins A, C, and E in combination, the only vitamin E, vitamin K and willow bark. There is insufficient evidence to make a recommendation on the safety and efficacy of these treatments.Chondroitin is not recommended in the treatment of osteoarthritis.

Manual therapies

While acupuncture causes a statistically significant improvement in pain, this improvement is small and may be of questionable clinical significance. Pending list controlled trials for osteoarthritis peripheral joints have not clinically relevant advantages, but these may be due to a placebo does not appear to produce effects.Acupuncture techniques electrostimulation benefits.While such long term dozens have been used for twenty years to treat osteoarthritis in the knee, there is no conclusive evidence to show that it reduces pain and disability.

Epidemiology

Disability-adjusted life year for osteoarthritis per 100,000 inhabitants in 2004.

no data

= 200

200-220

220-240

240-260

260-280

280-300

300-320

320-340

340-360

360-380

380-400

= 400

Overall about 250 million people suffer from osteoarthritis of the knee (3.6% of the population). OA affects nearly 27 million people in the United States, which represents 25% of visits to primary care physicians, and half of all NSAID prescriptions. It is estimated that 80% of the population have radiographic evidence of osteoarthritis at age 65, although only 60% of those who have symptoms. In the United States, hospitalizations for osteoarthritis increased by 322,000 in 1993 to 735,000 in 2006.

Overall OA causes moderate to severe disability in 43.4 million people in 2004.

In the United States, there were about 964,000 hospitalizations for osteoarthritis in 2011, a rate of 31 stays per 10,000 inhabitants. With a total cost of $ 14.8 billion ($ 15,400 per stay), it was the second most expensive given the state hospital stays in the United States in 2011. By payer, it was the second most expensive condition billed to Medicare and private insurance.

Etymology

OA is derived from the Greek word part arthrosis, meaning "bone", combined with arthritis: arthr, which means "common", and-itis, whose meaning has come to be associated with inflammation. The-ite of osteoarthritis could be considered misleading as inflammation is not an outstanding feature. Some clinicians refer to this condition as osteoarthosis to signify the absence of inflammatory reaction.

History

Evidence of osteoarthritis found in the fossil record is studied by paleopathologists, disease specialists and old injuries. OA has been reported in fossils of dinosaur Allosaurus fragilis large carnivores.