Internal Diseases and Therapy · MU Sofia

54. Osteoarthritis

Explains osteoarthritis as a degenerative cartilage disease with secondary bone change, covering risk factors, the primary and secondary classification, and the balance failure between cartilage synthesis and degradation. It then describes typical symptoms and joint sites, including Heberden and Bouchard nodes, and lists the differential diagnoses such as gout and rheumatoid arthritis. The note closes with stepwise management, from exercise and therapy through analgesia and injections to surgery.

Inside: 1 section · 2 labelled pictures · 15 flashcards · 4 min

Topic 54 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 1 section, about 619 words (4 min of reading), with 15 flashcards.

In this note

  1. Osteoarthritis

Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease characterised by pain and functional loss with a local (but not systemic) inflammatory process. There is articular cartilage and extracellular matrix damage which is visible on X-ray and causes loss of function.

OA is an age disease, with a high prevalence in countries with a long life expectancy. Risk factors include female sex (especially after menopause), genetics, obesity, and lifestyle

activities that involve repetative trauma (e.g. certain sports). It is the most common joint condition and the main differential in every large inflamed joint.

Osteoarthritis is in fact a degenerative disease of the articular cartilage, with bone inflammation being secondary. We distinguish osteoarthritis into two main types, primary, which is idiopathic, and secondary, where the disease is tied into well recognised predisposing factors (e.g. congenital diseases, developmental diseases, metabolic diseases, infections, genetic diseases and others). The disease mainly involves the large weight bearing joints (hip and knee being the most common), marking it as quite different from rheumatoid arthritis which predominantly affects the smaller joints. The incidence of OA increases with age, and is common in those over the age of 50, around 8.5 million people in the UK have the disease and it is more common in women than in men.

There is no single cause of OA, rather a collection of factors including age, hereditary disposition, increased weight with conditions such as congenital deformities or trauma increasing the risk.

In the affected joint there is a failure to maintain the balance of cartilage matrix synthesis and degradation, resulting from reduced formation or increased catabolism. This leads to focal cartilage loss that laters the joint anatomy, reducing the joint space (visible on x-ray) and causing permanent bone remodeling of the joint.

We classify osteoarthritis as follows:

  • Primary (idiopathic) - no preceding injury to the joint. Further categorised by anatomical location
  • Secondary - an insult to the joint previous to OA is identifiable (e.g. congenital hip dysplasia).

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