Osteoarthritis (OA) / Reading and Sharing

Osteoarthritis (OA) is primarily a disease of cartilage. Cartilage is a tissue with viscoelastic and compressive properties. It is predominantly composed of type II collagen and proteoglycans. In a normal condition the extracellular matrix undergoes a dynamic remodeling process in which low levels of degradative and synthetic enzyme activities are balanced. When OA is present, the matrix degrading enzymes will become overexpressed. This results in loss of collagen and proteoglycans from the matrix (Ling & Bathon, 2012). Once the articular cartilage breaks down, the progressive formation of osteophytes (bone spurs) protrude into the joint space decreasing joint movement.

Clinical manifestations of OA usually consist of pain, stiffness and functional impairment. Movement or exercise may aggravate the joint pain. The affected joint may have a decreased range of motion and may appear enlarged. OA often occurs in weight-bearing joints such as hips, knees, cervical and lumbar spine although the interphalangeal and distal interphalangeal joints may also be involved.

According to the Center for Disease Control (2017), Osteoarthritis (OA) affects nearly 30 million U.S. adults and it is often the elderly that are the most afflicted. Some factors that may cause OA may include mechanical injury, genetic and hormonal factors or previous joint damage. Risk factors may include older age, sex, obesity, and bone deformities. McCulloch, Litherland, and Rai, (2017), stated that OA is the most prevalent joint disease primarily affecting the knees and hips.  According to Badlissi (2017), a study by the Framingham Osteoarthritis Study showed that the prevalence of radiographic OA increases with age from 27% in people younger than 60 years to 44% to those older than 70 years. It further states that the incidence of hand OA could range from 2% to 4% per year.

As mentioned above, patient with OA present with primary symptoms of joint pain, locomotor restriction, and joint pain. Those symptoms could be presented in one or a few joints in middle-aged or older person. Other manifestations of OA in patients include sequelae such as weakness and poor balance or muscle weakness (Doherty and Abhishek, 2017). On examination the patient may present with joint tenderness and swelling, crepitus with motion, or Bouchard’s and Heberden’s nodes of the joints of the hand Ferri, 2018).

When treating OA, the main goal is educating the patient about the disease and ways to improve joint pain and stiffness. There is no cure for OA, but with a combination of different modalities treatment it can provide adequate pain control and preserve quality of life for patients that suffer this disease. There is no specific laboratory test to rule out osteoarthritis. But, depending on the patient’s history and inflammatory component an ESR, CBC, rheumatoid factor, and antinuclear antibody tests may be required. Also, a plain x-ray of the involved joint is useful in confirming joint spacing, subchondral sclerosis, or new bone formation in the form of osteophytes (Ferri, 2018).

Treatment may include nonpharmacologic and pharmacologic therapies, and, surgery. Some nonpharmacological therapy for the and may include using assistive device, thermal modalities, or joint protection techniques to name a few (Ferri, 2018). Nonpharmacologic therapy for the knee and hip may include medial wedge insoles for valgus deformities at the knee, patellar taping, assistive devices such as walkers or canes, or physical therapy to name a few (Ferri, 2018). Some pharmacological treatment as first line of treatment include local analgesics such as methylsalicylate cream or topical NSAIDS (Badlissi, 2017). According to Badlissi (2017), in conjunction with local analgesia, intra-arrticular corticosteroid injections with methylprednisolone 4-80 mg intra-articularly as a single dose or triamcinolone acetonide 2.5 to 40 mg intra-articularly as a single dose could also be used as a primary option of treatment. It further states, that patients with persistent pain despite multiple treatment or with severe disability, surgery may an option to replace the hip and knee.

Patients are to be monitored for the progression of the disease and treatment plan. Patient should consult with their physician if pain persist in their joints on most days for more than 1 month. Patients on NSAIDS or COX-2 inhibitors, should be seen every 3 to 6 months to monitor their renal function, CBC, and liver function tests. Patients with persistent or limitation in their daily activities, should be referred to a rheumatologist and/or orthopedist for further evaluation or possible joint replacement or other surgical options available (Badlissi, 2017).

References:

Badlissi, F. (2017). Osteoarthritis epidemiology – Epocrates online. Retrieved from https://online.epocrates.com/diseases/19223/Osteoarthritis/Epidemiology

Center for Disease Control. (2017). Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

Doherty, M., & Abhishek, A. (2017). Clinical manifestations and diagnosis of osteoarthritis. Retrieved from https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-osteoarthritis?

Ferri, F. F. (2018). Ferri’s clinical advisor 2018. Philadelphia, PA: Elsevier.

Ling, S. M., & Bathon, J. M. (2012, March 27). Osteoarthritis: Pathophysiology. Retrieved from https://www.hopkinsarthritis.org/arthritis-info/osteoarthritis/oa-pathophysiology/

McCulloch, K., Litherland, G. J., & Rai, T. S. (2017). Cellular senescence in osteoarthritis pathology. Aging Cell, 16(2), 210-218. doi:10.1111/acel.12562