Osteoarthritis: Types, Causes, Symptoms and Treatment

Arthritis is a condition that affects the joints and osteoarthritis is one of the most common types of arthritis. In this disease, the cartilage present in the joints wears away with time and that leads to its degeneration. The word osteoarthritis is a misnomer because there is not any inflammation.

Types Of Osteoarthritis

• Primary Osteoarthritis- There will be articular degeneration without any underlying cause.
• Secondary Osteoarthritis- The secondary type of osteoarthritis occurs in patients who have some pre-existing abnormalities like rheumatic arthritis, tuberculosis, and septic arthritis.

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Risk Factors/Causes of Osteoarthritis

Modifiable Risk Factors 

• Sedentary lifestyle
• Obesity
• Occupational joint loading 
• Diabetes mellitus

Non-modifiable Risk Factors

• Advanced age 
• Female sex
• Family history 
• Prior joint trauma

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Clinical Features/Symptoms Of Osteoarthritis

• Patient will be presented to the clinic with pain and stiffness of the knee joint.
• The morning stiffness will be brief and less than 30 minutes. 
• Crepitus and tenderness will be present over the medial joint line.

X-ray Findings

• Asymmetric narrowing of joint space will be seen. Only one side of the joint will be narrow and the other is normal.
• Sclerosis of subchondral bone in the form of tibial spikes are seen.
• Cysts can be seen in the joint surface
• A hook-like structure called an osteophyte will be seen at joint margins.
• In severe cases loose bodies are seen leading to true locking.

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                                            Osteoarthritis

Treatment Of Osteoarthritis

Non Surgical Treatment(Acute)

• Patient education and physical therapy should be provided.
• No unnecessary knee movements should be done, quadriceps strengthening exercises should be advised.
• The patient should be advised to get hot fermentation for 20 minutes.
• The patient should be counseled for weight loss.
• Knee bracing can be done
• NSAIDs are a very important aspect in the treatment of osteoarthritis because it’s a painful condition the drug of choice is paracetamol.
• Intraarticular injections like hyalase and steroids are also an important option.

Surgical Treatment (Chronic)

• High Tibial Osteotomy- Only done in the medial component of osteoarthritis, a small wedge of bone is taken below the narrowing and closed with the plate this will lead to the opening of a space. There is no bone replacement.
• Total knee arthroplasty is done in very severe cases.

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Pathophysiology Of Osteoarthritis

• There is progressive softening and disintegration of articular cartilage.
• A new growth of cartilage and bone occurs at joint margins.
•  The first microscopic change that appears in the cartilage is an increase in the water content. 
• The most common precursor of primary osteoarthritis is stress and the earliest sign is pain.
• The most concerning symptom is loss of function. 
• Genu varum is more common in osteoarthritis whereas genu valgum is more common in rheumatoid arthritis.
• Bulges can be seen in phalangeal joints. The bulge in the proximal phalangeal joint is called as Bouchard’s node and the bulge in the distal phalangeal joint is Heberden’s node.
• The joints mainly involved our knee joint, hip joint, distal interphalangeal joint and 1^st carpometacarpal joint.

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