Degenerative diseases of musculoskeletal system (coxarthrosis, Gonarthrosis, Spondylarthrosis)
Coxarthrosis and Gonarthrosis are both forms of Osteoarthritis. First we will consider the generalities of arteritis before going into detail about each 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 arteritis 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).
The most common symptoms of OA are pain, stiffness and swelling at rest. It most commonly affects the (gonarthrosis), hip (cox arthrosis) and small hand joints and the spine. Stiffness and joint pain are not usually present at night, and are worse when the joint is under strain, while morning stiffness is commonly present for around 30 minutes.
OA diagnosis is predominantly clinical, but an XR can help confirm the diagnosis, Rheumatoid factor, ESR and anti cyclic citrullinated peptide ABs could be helpful in distinguishing rheumatoid arteritis from OA. Diagnostic signs that one can look for include muscle wasting in the area and palpable tenderness in the joint.
The differential is:
- Bursitis
- Gout
- Pseudogout
- Rheumatoid arteritis
- Psoriatic arthritis
- Avascular necrosis
- Internal derangements