Degenerative Arthritis - Osteoarthritis

Degenerative Arthritis - Osteoarthritis

    * Introduction
    * Diagnosis
    * Treatment
Osteoarthritis is the most common joint disease and represents a heterogeneous group of pathological conditions common radiological and histopathological changes. It is a degenerative disease that occurs through biochemical destruction of the articular cartilage of synovial joints. Although osteoarthritis is considered to be the consequence of excessive weight and cartilage tears, secondary nonspecific inflammatory changes also affect the joints. By definition, the etiology of primary osteoarthritis is unknown, but the pathology and pathogenesis of osteoarthritis has been studied extensively.
History osteoarthritis has been divided into primary and secondary, although this division is artificial. Secondary osteoarthritis is more easily understood. It refers to degenerative disease of synovial joints with predisposing conditions, trauma that alters articular cartilage or subchondral bone. Secondary osteoarthritis occurs in younger people. The definition of primary osteoarthritis is unclear. Idiopathic is a phenomenon that occurs in joints intact, without apparent initiator factor. It is associated with the aging process and typically occurs in older people. Some doctors limit the disease in the hand joints, particularly the interphalangeal, while others include knee, hip, spine.
Osteoarthritis occurs with high incidence in elderly patient progresses. Primary Osteoarthritis is a common disease of old people and patients are usually asymptomatic. 80% of people over 65 years shows signs of primary osteoarthritis. Patients with symptoms not only notifies you after the age of 50 years. The prevalence of disease increases dramatically after 50 years, after this age due to alterations of collagen and by decreasing the intake of nutrients for cartilage proteoglycans and alterations incurred. Osteoarthritis typically develops slowly and progressively in a few years. The pain usually gets worse slowly, but it may stabilize in some patients. Knee osteoarthritis is a leading cause of disability in the elderly.
Today there are several treatments available to slow or stop progression of this common disease. The patient will avoid the application of mechanical pressure on the joints affected and will lose weight if they are overweight. Physical therapy may be recommended to preserve joint motion and flexibility. And acetaminophen are prescribed anti-inflammatory to relieve pain associated with the disease. Intra-articular pharmacological therapy includes administration of corticosteroids and viscosuplimentare injections. If these therapies are ineffective surgical intervention with total arthroplasty or arthroscopic procedures.
Pathogenesis of degenerative arthritis (osteoarthritis) Normal articular surface of synovial joints composed of hyaline cartilage consists of chondrocytes surrounded by extracellular matrix that includes different macromolecules, the most important being proteoglicanii collagen. Pretejeaza cartilage subchondral bone by distributing mechanical load, maintain limited contact and reduce friction joints. A variety of factors, particularly age, leading to the development of primary osteoarthritis, however, primary and secondary osteoarthritis are not separable as a pathological basis. Most scientists believe that degenerative alterations begin in the articular cartilage as a result of excessive mechanical loading of the joint healthy or normal loading of the affected joints. External forces accelerate the catabolic effects of chondrocytes and cartilage matrix interrupt.
Enzymatic degradation of cartilage destruction increases, accompanied by a decrease in proteoglycans and collagen synthesis. Changes in cartilage proteoglycans are less resistant to compressive forces from the joint and more succeptibil to stress. Cystic degeneration of subchondral bone trauma suffered by secondary bone necrosis or chronic impactarii intrusion of synovial fluid. In areas without pressure along the edge joint, bone marrow vasculature, bone metaplasia of synovial tissue and cartilage ossification lead to the formation of protrusion of bone spurs. Their fragmentation or cartilage leads to the formation of intra-articular foreign bodies. Causes and risk factors for arthritis: -Old age, obesity, female sex -Trauma, infection, repetitive occupational trauma -Genetic factors, history of inflammatory arthritis -Neuromuscular disorders, metabolic.
Signs and symptoms in osteoarthritis: Primary Osteoarthritis occurs mainly at the hand, the distal interphalangeal joints, proximal and first metacarpophalangeal. Also some people may start to take place in knee, hip, neck or low back region. Deep pain in the form of cramps, joint physical activity is the first symptom. Movements and also reduces crepitantele are commonly present. Malaliniamentul joint may be visible. Bone spurs can palpate the distal interphalangeal joints, characteristic of women. Inflammatory changes are typically absent or weakly pronounced. Pain: -Is the main reason that patients see a doctor -Initially symptomatic patients experience pain during activity, relieved by rest and that responds to simple analgesics -Morning stiffness lasts less than 30 minutes -Stiffness may develop during the rest -Joints can become unstable as the osteoarthritis progresses, pain is so prevalent and no longer respond to medication.
Pain in osteoarthritis is initiated by: Epansamentele-articular and articular capsule stretching Vascular pressure-increase in subchondral bone Inflammation of the peri-stock Peri-muscle spasm -Psychological factors -Palpated crepitus during movements in the affected joint.
Subsets of primary osteoarthritis: Some diseases are categories or subsets of primary osteoarthritis. These include primary generalized osteoarthritis, erosive osteoarthritis and inflammatory Petelea Chondromalacia. Primary generalized osteoarthritis: Cluster is characterized by premature onset familial and Bouchard and Heberden nodules, as early degeneration of articular cartilage of multiple joints, including carpometacarpiana, knee, hip and spine. Radiographic appearance is similar nonfamiliala form of osteoarthritis, although the disease progresses rapidly and is severe. Erosive osteoarthritis: It is a form of primary osteoarthritis marked by a high degree of inflammation, with abnormalities and erosive bone stiffness in some cases. The disease occurs mainly in postmenopausal women and may be hereditary. It is typically bilateral and symmetrical and distal interphalangeal. Rarely patients may have erosive osteoarthritis of the first metacarpal at the base or foot. Radiographic erosions are centrally located from the marginal rheumatoid arthritis. Bone spurs are present. It is obvious soft tissue swelling and bone fusion joint that limits movement. Chondromalacia patella: Occurs mainly in young adults. It is a syndrome with crepitus and pain associated with previous knee cartilage changes over the surface of the patella.

Diagnosis

Laboratory studies:
-There are no specific laboratory abnormalities for osteoarthritis
the acute-phase reactants and erythrocyte sedimentation rate are normal
synovial fluid-analysis indicates predominant mononuclear leukocyte sub 2000/microL.Imaging Studies:
Radiography of affected joints, bone spurs show this characteristic, asymmetric collapse joint space, subchondral sclerosis, subchondral cyst formation.
Arthrocentesis is often performed to support the differential diagnosis of septic arthritis or crystal. This procedure relieves the pain associated with effusion. Samples of joint fluid is sent to the analysis if infection is suspected or crystal arthritis.
Arthroscopy is indicated after all conservative treatments have failed. Procedure directly visualize joint.
The differential diagnosis is made with the following conditions: rheumatoid arthritis, reactive arthritis, condrocalcinoza.


Treatment
Is pharmacological therapy of choice in osteoarthritis and include patient education, weight loss, thermal control, exercise, physical therapy, occupational. Stress relief joints: Instructs the patient to avoid worsening of mechanical stress on affected joints Proper posture is recommended Encourage the obese to lose weight to relieve stress and balance genunchiu mechanically. Physical Therapy: Cause atrophy of knee osteoarthritis, quadriceps, muscles that help protect the articular cartilage Will perform the aerobic exercise -Hydrotherapy can have benefits Local heat-and capsaicin topical cream, or ice relieves the pain and stiffness.
Pharmacological Therapy: We want pain relief and functional status. The treatment begins with acetaminophen for moderate pain without apparent inflammation. If clinical response to acetaminophen is not satisfactory or if the clinical presentation is inflammatory is administered NSAIDs. Use the lowest dose if the pain is intermittent and most if patient response is not sufficient. Options for patients with gastrointestinal toxicity of NSAIDs include the addition of a proton pump inhibitor or misoprostol regimen or the use of selective cyclooxygenase inhibitors.
In patients with significant pain, tramadol is administered resistance. Muscle relaxants are helpful for patients with muscle spasms. Intra-articular corticosteroid injections improve symptoms. Should not be taken more than four injections in a single year because of the risk of joint cartilage destruction. Systemic corticosteroids have no role in controlling osteoarthritis. Intra-articular injections of hyaluronic acid therapy is symptomatic knee damage.
Surgical therapy: Joint lavage is beneficial to a small group of patients. Arthroscopy can help patients with knee osteoarthritis that imaging shows specific structural destruction, to repair cracks, meniscus, meniscus removed fragments that produce symptoms. Osteotomy is indicated in patients with hip or knee malalinierea. The procedure is recommended in young patients with osteoarthritis. Osteotomy can relieve pain. Arthroplasty is performed if the rest of the methods are inefficient and not viable osteotomy. This procedure improves pain and function.
Surgical Complications: Infection is the most feared complication of postsurgical, especially in cases of total arthroplasty. Prevention resultant thrombophlebitis and pulmonary embolism is important in patients suffering from lower limb arthroplasty. The success rate of hip and knee arthroplasty is 90%. The longevity of prosthetic implant depends on patient activity. Young and physically active patients will require reintervention.