Introduction
Osteoarthritis (OA) is a form of arthritis that features the breakdown and eventual loss of the cartilage of one or more joints. It is a degenerative arthritis.
- All forms of assault on the joint or any other arthritis will result in OA
- It is a degenerative disease of synovial joint – osteoarthritis
- Degenerative disease of
intervertebral disc is spondylosis - OA is the commonest type of arthritis and affects mostly middle aged to elderly persons
- Females are more frequent affected than males:
- OA causes are mostly primary, but can be secondary
- Secondary causes include
- previous trauma to the joint,
- meniscal injury,
- any previous arthritis e.g. Gout, RA;
- Congenital hip dysplasia;
- Epiphyseal: dysplasia;
- hypermobility syndromes,
- previous poliomyelitis in the limb,
- glycogen storage disorder.
- Joints affected mostly are the knee, hip, ankle, distal and proximal interphalangeal joints of the hands, cervical, & Lumbosacral.
- Rarely thoracic spine.
Clinical features:
- Joint pain developing over several weeks or even years
- Initially pain on movement but later at rest
- Joint warm to touch
- Minimal joint morning stiffness
- Creakiness (crepitus) on walking
- Swelling of the joint may be bony
osteophytes, or soft due to effusion - Presence of Heberden’s nodes (Distal Interphalangeal joint); & Bouchards nodes (proximal interphalangeal joint)
- Joint deformities – knee – Genu Varus, Genu Valgum
Complications
- Joint deformity
- Joint subluxation
- Immobility
Differential Diagnosis
- Rheumatoid Arthritis
- Gout
- Psoriatic arthritis
- Bursitis
- Ankylosing spondylitis
Investigations
None diagnostic
- Investigations are done to exclude other diagnosis
- No blood tests diagnostic
- Imaging – X-ray; CT, MRI
Treatment objectives
- Reduce pain
- Enhance mobility
- Prevent deformities
Treatment
A. Non-drugĀ treatment
- Patient education
- Weight loss
- Avoidance of excessive flexion of joint such as the knee
- Knee brace, feet insoles, walking sticks
- Regular exercise walking, bicycling,
swimming. Avoid jogging, if knee is
affected - Physical therapy – Quadriceps strengthening exercise, range of motion exercises
- Occupational therapy
- Acupuncture
- Transcutaneous electrical nerve stimulation (TENS) therapy
B. Drug Treatment
Paracetamol
500 mg to 1g orally every 8 hours daily (up to 4gm daily in divided dose)
NSAIDs
Oral or local application
- Mainstay of treatment is NSAIDs (none is superior to the other); depends on patients response
- Ibuprofen
- 400mg – 800 mg every 8 hours daily (up to 2400mg daily in divided doses)
- Diclofenac–
- 75mg-150mg in two to three divided doses daily
- Naproxen 500mg BD
- COX 2 inhibitors- Celebrex- 200mg daily;
- Diclofenac gelĀ
- Apply on the affected part up to 3 – 4 times daily
- Capsaicin cream 0.075%
- Apply on the affected part up to 3 – 4 times daily
NSAIDs with misoprostol or PPI
Intra- articular steroid
Not to be given more than four times in the year
- Triamcinolone
- 5- 40 mg by intra articular/ intradermal injection
according to patient’s size (maximum 80 mg), may be
repeated when relapse occurs
- 5- 40 mg by intra articular/ intradermal injection
Or:
- Methylprednisolone
-
- 4- 80 mg (depending on patient’s size) intra articularly; may be repeated at intervals of 7-35 days
Intra-articular platelet rich plasma
- Intra-articular platelet rich plasma is a promising treatment option for OA. Read more about it here in comparison with intra- articular steroid
Hyaluronate
-
- Injected into the joint (usually the knee), results in pain relief in 1- 6 months, but increases inflammation in the short term.
Glucosamine/chondroitin
- (triple strength i.e. 750/600 mg) one tablet orally every 12 hours.
Narcotic analgesics:
- Morphine 5 – 20 mg orally every 4 hours
- Codeine based compound,
- Tramadol
Adverse Drug reactions
NSAIDS
- Dyspepsia
- Peptic Ulcer Disease,
- Gastro-intestinal haemorrhage,
- Perforation,
- Hepatotoxicity,
- Impairment of renal blood
flow - Pyloric stenosis
- Fixed drug eruptions,
- Constipation
- Skin rashes
Indications for surgery
- Intractable pain
- Disability
- Deformity
Prevention
- Reduce weight
- Regular exercise