-IBIS-1.5.0-
tx
musculoskeletal system
osteoarthritis
diagnoses
definition and etiology
definition:
Degeneration and loss of the articular cartilage, with concurrent subchondral bony sclerosis, cartilage and bony proliferation at the joint margins, and the growth of osteophytes. Also called "the wear and tear disease"; "Degenerative joint disease: DJD"; and just "arthritis".
etiology:
This is the most common form of arthritis and can affect all the joints, but has special affinity for the weight-bearing joints (knees, hip, spine). It is seen in both men and women, men usually before 45 years old, and women after 45-55 years old. OA is universal and appears to have a hereditary tendency. The initiating factors include poor diet, trauma, and repetitive forceful stress to a joint, although the exact cause is unknown.
signs and symptoms
signs and symptoms:
Onset is gradual and begins in one or a few joints.
Pain: deep, aching; worse movement and reducing barometric pressure, and better rest and warmth.
Stiffness: worse morning upon rising, and after periods of rest during the day; lasts 15-30 minutes; better moving.
Trouble sleeping at night from pain and stiffness.
Tenderness to palpation and Heberden's nodes (distal interphalangeal joints) can sometimes be palpated (they are especially seen in women with OA).
Joint crepitus with movement.
Weakness of the joint on weight bearing.
Common joints affected: DIPs of hands, shoulders, spine, knees, hips.
Chronic symptom picture may be punctuated by acute flare-ups of pain, swelling and stiffness.
lab findings:
ESR: Normal or slightly increased.
(-) RF.
(-) synovial fluid analysis.
(+) X-ray changes: osteophytes, bone cysts, narrowed joint space, subchondral bony sclerosis.
Decreased ROM.
course and prognosis
Although the disease is typically benign, in severely affected knees, hips or spinal OA, the patient may be disabled. Pain, stiffness, and decreased ROM tends to increase and worsen progressively. Chronic pain can cause depression and a poor outlook on life that decreases health in general. Conventional treatment focuses on pain relief, exercise and weight loss and applies surgery (like joint debridement, fusion and osteotomy) in advanced cases.
differential diagnosis
Rheumatoid arthritis.
Psoriatic arthritis.
Reiter's syndrome.
Chondrocalcinosis.
OA variants: erosive inflammatory osteoarthritis and diffuse idiopathic skeletal hyperostosis.
footnotes