Outline
Pathogenesis
of OA
Clinical
Features of OA
Management
of OA
References
Buckwalter JA and Mankin HJ (1998). Articular cartilage:
tissue design and chondrocyte-matrix interactions. Instr Course
Lect.;47:477-86
Buckwalter JA and Mankin HJ (1998). Articular cartilage: degeneration
and osteoarthritis, repair, regeneration, and transplantation.
Instr Course Lect.;47:487-504.
Camasta CA (1996). Hallux limitus and hallux rigidus. Clinical examination,
radiographic findings, and natural history. Clin Pod Med Surg; 13:
423-448.
Rosenstein ED (1999). Topical agents in the treatment of rheumatic
disorders. Rheum Dis Clin North Am; 25: 899-918.
Roth A et al (1982). Osteoarthritis of the tarsal bones of the foot.
JAPMA; 72: 244-247.
Roth A (1982). Talonavicular joint osteoarthritis (Osteoarthrosis).
JAPMA; 72: 237-243.
Simon LS (1999). Osteoarthritis: A review. Clinical Cornerstone;
2: 26-34.
Synovial joint: anatomy
Almost
all joints of the limbs
Contain/consist
Joint
cavity - synovial fluid
Joint
capsule and synovium
Articular
cartilage
Subchondral
bone
Articular cartilage structure
Articular cartilage function
Articular cartilage physiology
Chondrocytes
synthesise and maintain ECM
Rates
of synthesis and catabolism of ECM molecules are in equilibrium
Proteinases
Collagenases
Aggrecanases
Osteoarthritis (OA)
‘A
clinical syndrome characterised by progressive loss of articular
cartilage,…remodelling and sclerosis of subchondral bone,
& formation of …marginal osteophytes’ (Buckwalter
& Mankin, 1997).
inflammation
- ‘mild & inconsistent’
OA
epidemiology
15%
prevalence in population (Hadler, 1985)
prevalence
rises exponentially with age
radiological
OA -
< 5% in population < 25 y.o.
> 80% in population > 80 y.o.
Pedal
OA - 20% prevalence in adult population (Lemont & Gibley, 1982)
Prevalence
of OA in lower limb
Knee>First
MPJ >hip, talocrural, subtalar and transverse tarsal joints.
Fifth MPJ rarely affected (Muehleman et al., 1997)
OA
pathogenesis
Symptoms & signs
Classification of OA
Risk Factors
Ageing
Obesity
Bone
Density
Joint
dysplasia
Trauma
Occupation
Family
history
Clinical Features
Clinical
symptoms and signs
Further testing:
Radiographic findings
Common Clinical Variants
Management of OA
Management objectives
Psychologic coping and social support
Physical
therapy
Reduction
of factors causing excessive joint loading
Pharmacological
approaches
Psychological coping
Physical therapy – “use it or lose it!”
Reduction
of factors causing excesive joint loading
OA
MEDIAL knee - lateral heel wedges (5-10º) (Keating et al.,
1993; Yasuda & Sasaki, 1985; 1987; Wolfe & Brueckmann, 1991)
OA
LATERAL knee - medial/varus heel wedges (5-10º) (Ogata et al.,1997;
Wolfe & Brueckmann, 1991)
Mechanism
of action of foot wedging on knee OA
Pharmacological
approaches
Local
preparations
topical agents
intra-articular injections
Systemic
preparations
Topical preparations (NSAIDs, rubefacients and capsaicin)
Intra-articular therapy
Long-acting
corticosteroids (eg, hydrocortisone)
Hyaluronan
(‘Viscosupplementation’)
Systemic
therapy
Analgesics
and NSAIDs: mainstay of traditional pharmacological management of
OA
COX2 inhibitors (Celecoxib, Rofexicob)…
New approaches
Chondroprotection
- modifying the pathogenesis of OA
Pentosan
polysulfate (Cartophen Vet®)
www.arthritis.au.com/htm/home.htm
Polysulfated
glycosaminoglycan (Adequan®)
(www.luitpold.com)
‘Viscosupplementation’
Natural
therapies
glucosamine, chondroitin sulfate, omega-3 fatty acids and others...
Things
to know:
Structure of cartilage and changes in OA
Aetiological factors of OA
Symptoms and signs of OA
Management
Non-pharmacological approaches
Pharmacological approaches
|
