Osteoarthritis Definition

Degenerative arthritis/ degenerative joint disease/ osteoarthrosis =

degeneration of the articular cartilage Mechanical abnormalities involving degradation & degeneration of joints Occurs in synovial/ small joints and is characterized by cartilage loss with an accompanying periarticular bone response cartilage, subchondral bone, ligaments, menisci, synovium and capsule is involved

Morphology

enlargement, proliferation, and disorganization of the chondrocytes in the superficial part of the articular cartilage accompanied by increasing water content of the matrix with decreasing concentration of the proteoglycans (the proteoglycan component conveys turgor and elasticity) vertical and horizontal fibrillation and cracking of the matrix occur as the superficial layers of the cartilage are degraded Eventually, full-thickness portions of the cartilage are lost, and the subchondral bone plate is exposed. Friction smooths and burnishes the exposed bone, giving it the appearance of polished ivory (bone eburnation)

Structural Changes in OA
Enlargement and disorganization of the chondrocytes Fibrillation and splitting of the articular cartilage giving a frayed appearance to the surface * Deep fissures develop with fragmentation and detachment of cartilage fragments Portions of the articular cartilage are eventually eroded

Surface of the exposed subchondral bone becomes thickened and polished (eburnation)
Loose bodies form from free-floating cartilage and bone fragments Synovial fluid leak through defects in underlying bone to form cysts

Underlying trabecular bone becomes sclerotic due to increase surface pressure Bone proliferation at margins of joints produce osteophytes
Non-specific inflammation of synovial membrane develops

Causes

Signs and symptoms

Symptoms: Joint pain Joint gelling (stiffening and pain after immobility) Joint instability Loss of function. Signs: Joint tenderness Crepitus on movement Limitation of range of movement Joint instability Joint effusion and variable levels of inflammation Bony swelling Wasting of muscles. Deterioration of Cartilage: Early stages: the surface of the cartilage becomes inflamed and swollen. The joint loses proteoglycan molecules and other tissues. This joint then begins to lose water. Fissures and pits appear in the cartilage. As the disease progresses and more tissue are lost, the cartilage starts to get hard. As a result, it becomes increasingly prone to damage from repetitive use and injury. Eventually, large amounts of cartilage are destroyed, leaving the ends of the bone within the joint unprotected. Complicating the process are abnormalities in the bone around arthritic joints. As the body tries to repair damage to the cartilage: Clusters of damaged cells or fluid-filled cysts may form around the bony areas or near the fissures in the cartilage. Fluid pockets may also form within the bone marrow itself, causing

Pathophysiology

Tests and diagnosis

Treatment/ management

swelling. The marrow, which runs up through the center of the bone, is rich in nerve fibers. As a result, these injuries may cause pain in many patients with osteoarthritis. Bone cells may respond to damage by multiplying, growing, and forming dense, misshapen plates around exposed areas. At the margins of the joint, the bone may produce outcroppings, on which new cartilage cells (chondrocytes) multiply and grow abnormally. Blood tests. There is no specific test; the ESR is normal although high sensitivity CRP may be slightly raised. Rheumatoid factor and antinuclear antibodies are negative. X-rays are abnormal only when the damage is advanced. They are useful to assess severity for operative intervention. For knees, a standing X-ray (stressed) is used to assess cartilage loss and skyline views in flexion for patello-femoral OA. MRI demonstrates meniscal tears, early cartilage injury and subchondral bone changes. Arthroscopy reveals early fissuring and surface erosion of the cartilage. Aspiration of synovial fluid (if there is a painful effusion) shows a viscous fluid with few leucocytes and occasionally calcium pyrophosphate crystals Principle: treat the symptoms and disability Depression and poor quadriceps strength are better predictors of pain than is radiological severity in OA of the knee. Education of the individual about the disease and its effects reduces pain, distress and disability and increases compliance with treatment. Psychological or social factors alter the impact of the disease