Donny Permana, dr.
Chronic Disorders of Synovial joints in which there is
Progressive Softening and Disintegration of Articular Cartilage
and Bone at the joint margins(Osteophyte), cyst formation and
sclerosis in the subchondral bone, mild synovitis and capsular
fibrosis.
Osteoarthritis shows features of both Destruction and Repair.
OA is dynamic phenomenon, it
shows destruction and repair
Chronic join disorder
Progressive softening and disintegration of cartilage
VS
New growth of cartilage and bone at the join margin
Capsular fibrosis
Osteoarthritis
Pathophysiology
Every joint comes with a natural shock absorber in the form of cartilage.
This cushions the ends of the bones and reduces friction in healthy joints.
As we Age, joints become stiffer and cartilage is more vulnerable to wear and tear.
Repetitive use of the joints over the years irritates the cartilage. If it deteriorates
enough, bone rubs against bone, causing pain and reducing range of motion.
Damage cartilage Failure in distributing force alter subchondral bone
(focal degeneration and cyst foration)
Join unstable endochondral ossifcation (osteophytes)
Pathogenesis
Cardinal feature :
1. Progressive cartilage destruction
2. Subarticular cyst formation
3. Sclerosis of surrounding bone
4. Osteophyte formation
5. Capsular fibrosis
Pathology
Symptom
After middle age
No Systemic manifestation of Degenerative Disease
Usually on Weightbearing joints (Hip or Knee), On the interphalangeal joints.
PAIN is usual presenting symptom, it is aggravated by exertion and relieved by rest
STIFFNESS is usually occurs after periods of innactivity
SWELLING
DEFORMITY may result from capsular contracture or joint instability
LOSS of FUNCTION
Sign
JOINT SWELLING due to an effusion
DEFORMITY
LOCAL TENDERNESS
LIMITED MOVEMENT ,associated with pain at pain at extremes of
motion
CREPITUS ,may be felt during passive movement
INSTABILITY (in late stages) due to loss of cartilage and bone,
asymmetrical capsular contracture and / or muscle weakness
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Clinical features
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0 Stage : Normal Stage, No sign or symptom of
Osteoarthritis, Pain (-)
1st Stage : Pain / Discomfort (-), Very Minor Bone
Spur growth
2nd Stage : Mild Pain / Discomfort, Joint Stiffness (+)
Tenderness (+), Greater bone Spur
growth, Space between the bones is Normal,
Synovial fluid still present at sufficient
levels for normal joint motion
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3rd Stage : Pain (+) on walking, running, bending or
kneeling, Joint Stiffness (+) after sitting for
long periods, Tenderness(+), Narrowing
Space between bones, Obvious damage on
cartilage
4th Stage: Severe Pain and discomfort when walking
or moving the joint Joint Space
dramatically reduced, Cartilage is almost
completely gone, Joint Stiffness(+) and possibly
Immobile, Synovial fluid is dramatically
reduced
Radiologis
Complication
Leads to Deformities that take a toll on mobility.
Severe loss of cartilage in the knee joints can cause the knees to
curve out, creating a bow-legged appearance.
Bony spurs along the spine can irritate nerves, leading to pain,
numbness, or tingling in some parts of the body.
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Treatment
There are no spesific cure for degenerative joint disease
Aims of Treatment :
1.to help the patient understand the nature of the disease
2.to provide psychological support
3.to alleviate pain
4.to suppress the inflamatory reaction
5. to encourage the patient to remain as physically active as
possible in order to maintain joint function and prevent deformity
6. to correct existing deformity
7. to improve function
8. to strengthen weak muscle
9. to rehabilitate the individual patient
Method of Treatment
1. Psychological consideration
2. Therapeutic Drugs : Salicylates, NSAID, Korticosteroid
inj (Temporary)
3. Orthopaedic Appliances : Crutches, Removable Splint,
Day Braces etc
4. Physical Therapy : Active movement of involved
joint (to preserve joint motion
and maintain muscle strength
etc), local heat on involved joint
5. Orthopaedic Surgical Operation :
Should be considered at a relatively early stage and not as a last resort.
Once the degenerative changes have become severe, only destructive
operation can be expected to i mprove the situation
Losing weight is one of the most effective ways to relieve pain !!!
Surgical: arthroscopy
Used to fix specific structural damage on imaging
Helpful for certain symptoms, such as mechanical locking or catching.
Repairing a meniscus tear or clean loose body in the knee.
