by: Raka Aji

Rizka Fegi
Ni Nyoman Pipit

PRESEPTOR:
dr Aswedi Putra, Sp.OT
FICS

“OSTEOARTHRITIS"
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What is Osteoarthritis (OA) is a

Osteo- chronic disorder
synovial joints in which
of

arthritis? there is progressive

softening and
disintegration of articular
cartilage accompanied by
new growth of cartilage
and bone at the joint
margins (osteophytes),
cyst formation and
sclerosis in the
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○ Weight bearing joints e.g knee & hip joints

○ Age >65 years
Epidemiology -80% have radiographic features
-25-30% have symptoms
○ More common in women
○ Familial tendency
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○ PRIMARY/IDIOPATHIC
When there is no obvios presdisposing
Etiology factor. Common form of OA

○ SECONDARY
When degenerative joint changes occur in
response to a recognizable local or systemic
factor
 Cause of secondary Osteoarthritis 9

 Developmental : Hip dysplasia

 Endocrine : Acromegaly

 Traumatic : Intra-articular fracture, occupational,

menisectomy

 Inflamation : RA, Arthritis Gout, Septic arthritis

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Risk CONSTITUTIONAL
MECHANICAL
SUSCEPTIBILITY
Factors FACTORS
1. Heredity
1. Trauma
2. Gender/ AGE
2. Joint shape
hormonal status
3. Aligment
3. Obesity
4. Usage:
4. High bone
occupational
mineral density
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Progressive destruction & loss of articular

cartilage with an accompanying peri-
Pathogenesis articular bone response leads to exposure of
sub-chondral bone which becomes sclerotic,
with increased blood vascularity & cyst
formation.
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Clinical PAIN MORNING RESTRICTED

FUNCTIONALITY
○ Activity & weight STIFFNESS
Features bearing related, ONLY BRIEF ○ Capsular
relieved by rest <30 minutes thickening
○ Variable over ○ Blocking by
time osteophytes
○ Only one or few
joints involved
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 Kellgren and Lawrence system for classification
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Grade 1 Grade 2
doubtful joint space narrowing (JSN) and definite osteophytes and possible JSN
possible osteophytic lipping on anteroposterior weight-bearing
radiograph
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Grade 3 Grade 4
multiple osteophytes, definite JSN, sclerosis, large osteophytes, marked JSN, severe
possible bony deformity sclerosis and definite bony deformity
Clinical findings in generalized OA 16

 Presentation typically in women (40-50years)

 Pain
 Stiffness
 Swelling of one or few finger interphalangeal
joints (distal>proximal)
 Heberden’s nodes (+/- Bouchard’s nodes)
 Involvement of first carpometacarpal joint is
common
 Predisposition to OA at other joints specially
kness.
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○ Targets patello-femoral & medial tibio-femoral
compartements of knee
Clinical ○ Pain is localized to anterior or medial aspect of
knee & upper tibia
findings in ○ Varus deformity
knee OA ○ Joint line & periarticular tenderness
○ Weakness & wasting of quadriceps muscle
○ Restricted extension & flexion
○ Bony swelling around joint
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 ○ Targets mostly superior
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aspect & less commonly
medial aspect of joint
○ Pain is maximally deep
Clinical in groin area
findings in ○ Antalgic gait
hip OA ○ Weakness & wasting of
muscle (quadriceps &
gluteal)
○ Pain & restricted internal
rotation with flexion
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Clinical
○ Before the age of 45 years
findings in
○ Single or multiple joint involvement
early-onset
○ Typical signs & symptoms of OA
OA
 DIFFERENTIAL DIAGNOSIS
FEATURES OSTEOARTHITIS RHEUMATOID ARTHRITIS ARTHRITIS GOUT

Presence of Systemic symptoms are not Frequent fatique and a general Chills and a mild fever a long
symptoms present feeling of being ill are present with a general feeling of
affecting the malaise may also accompany
whole body: the severe pain and
inflammation

Duration of Morning stiffness lasts less Morning stiffness lasts longer Not seen
morning than 30-60 mins than 1 hour
stiffness
Nodules Heberden’s & bouchard’s Heberden’’s nodes are absent
nodes
Pain with Movement increases pain Movement decreases pain
movement
Age of onset Most commonly occurs in Usual age of onset is >20 Usually over 35 years of age in
individuals is over the age men and after menopause in
of 50 females
Lab findings Ra factor & anti-ccp Ra factor & anti-ccp antibody Joint fluid microscopy is
antibody negative. Normal positive. Esr & c-reactive diagnostic
esr & c-reactive protein protein elevated
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Radiographic features
The hallmarks of knee osteoarthritis are the same for
most other joints :
• Joint space narrowing
- usually asymmetric, typically of the medial tibiofemoral
compartment, and/or patellofemoral compartment .
- <3 mm on weight-bearing knee radiographs is
considered a finding of absolute joint space narrowing
with a normal joint space >5 mm.
- weight-bearing radiographs will demonstrate more joint
space narrowing than non-weight-bearing radiographs,
hence affecting the radiographic severity .
• Subchondral sclerosis
• Marginal osteophytes
• Subchondral cyst (geodes)
• Altered shape of the femoral condyles and tibial
plateau
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MRI
The following features are seen
additionally on MRI :
• synovial thickening
• bone marrow oedema
• cartilaginous defects (partial or
complete)
bursitis
• iliotibial band syndrome
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Investigations

○ Blood test:
-FBC : normal
-ESR : normal
-CRP : normal
-Rhematoid factor : normal

○ Sinovial fluid analysis:

 Criteria diagnostic based on American College of rheumatology
clinical 25
radiograph

Knee joint Knee pain + min 1 of ( Nur,2009 )

Knee pain + min. 3 of 6 criteria criteria below :

below : 1. Osteophyte

1. Age > 50 y.o 2. Asymetrical narrowing of the

2. Morning stiffness < 30 minutes joint space and often

3. Crepitation changes in anatomy of the

4. Tenderness joint

5. Bone enlargement 3. Subcondral cyst and

6. No heat on touch sclerosis.

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○ NON- PHARMACOTHERAPY

Manageme
nt
○ PHARMACOTHERAPY

○ SURGICAL INTERVENTIONS
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NON-
PHARMACOTHERAPY

 Full explanation of the condition via patient education:

• Properly position and support your neck and back while sitting or sleeping
• Adjust furniture, such as raising a chair or toilet seat
• Avoid repeated motions of the joint, especially frequent bending
• Lose weight if you are overweight or obese, which can reduse pain and
slow progression of OA
• Exercise each day
• Build confidence
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NON-
PHARMACOTHERAPY

 Exercise
Swimming, cycling, aerobic

 Reduction of adverse mechanical factors

Weight loss
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PHARMACOTHERAPY
WEAK OPIOIDS
• Occasionally required
PARACETAMOL
• E.g: dihydrocodeine
• Initial drug of choice
• Orally 1mg 6-8 hourly
INTRA-ARTICULAR
CORTICOSTEROIDS
INJECTIONS
NSAIDs • 5 weekly
• Indicated as needed
• Oral e.g : ibuprofen &coxibs
• Topically e.g: capsaicin HYALURONIC INJECTIONS
0,025% cream • Injections for 3-5 weeks
• Pain relief for several
months
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SURGICAL TREATMENT

 Should be considered for those who do not give response

to pharmacotherapy
• Osteotomy
• Arthroplasty
Total Arthroplasty, Hemi Arthroplasti
Happy Watching 
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