Osteoarthrosis

Osteoarthrosis (OA) is a heterogeneous group of diseases with a common clinical picture and X-ray findings.

Epidemiology
Globally, about 250 million people suffer from osteoarthritis, which represents 3.6% of the world's population.

Etiology
The disease is multifactorial, with predisposing systemic factors (genetic, hormonal, and endocrine) and local influences.

Clinical presentation



 * exertional and starting pains;
 * joint stiffness after inactivity (typically in the morning), lasting for 15-30 minutes;
 * limited joint mobility;
 * sound phenomena (crepitus, grinding);
 * joint deformities.

X-ray findings
Narrowing of the joint space, subchondral sclerosis, cysts, and osteophytes on the edges of the joint surfaces.

Primary (idiopathic)

 * localized;
 * generalized (3 or more joints);
 * erosive.

Secondary (symptomatic)

 * due to mechanical overload and incongruity of joint surfaces (DDH, Perthes disease);
 * due to inflammatory joint diseases (arthritis);
 * due to endocrinopathies (acromegaly, hyperthyroidism, DM);
 * due to metabolic changes (chondrocalcinosis);
 * due to neuropathies (Charcot's osteoarthropathy in DM).



Kellgren-Lawrence

 * Classification based on the severity of X-ray findings:

I. joint space narrowing

II. joint space narrowing, subchondral sclerosis on X-ray, osteophyte formation

III. joint space narrowing, subchondral sclerosis on X-ray, deformation of joint cavity and head, osteophytes

IV. vanished joint space, subchondral sclerosis on X-ray, deformation, cysts, osteophytes

Localization of changes in osteoarthrosis

 * Hands – Heberden's nodes (deformities of the distal interphalangeal joints - DIP), Bouchard's nodes (deformities of the proximal interphalangeal joints - PIP), rhizarthrosis (carpometacarpal joint of the thumb);
 * Feet – hallux valgus, hallux rigidus;
 * Knees – gonarthrosis;
 * Hips – coxarthrosis;
 * Spine – spondyloarthrosis (intervertebral joints), spondylosis (vertebral bodies), discopathy (intervertebral discs);
 * Shoulders – omarthrosis.

Generalized OA
It is divided into nodal, non-nodal, and erosive types.

Pathogenesis

 * Combination of degenerative, inflammatory, and reparative changes affecting articular cartilage (loss of proteoglycans and impaired synthesis of collagen by chondrocytes), subchondral bone (sclerosis, cysts, formation of osteophytes), ligaments, tendons, and synovium.


 * As a consequence of degenerative and biochemical changes, the cartilage loses its luster, softens, and develops fissures on its surface. Gradually, it becomes less resilient and experiences losses.


 * Subchondral bone undergoes sclerosis, cysts form within it, and osteophytes (bony outgrowths) form on its edges.


 * Osteoarthritis is a disease of the entire joint structure (not just articular cartilage).


 * OA is a very common disease, affecting up to 80% of the population over the age of 50. However, degenerative changes may also occur at a younger age.

Diagnosis
The standard is an X-ray with typical changes, while laboratory tests are inconclusive.

In '''dif. dg.''' we think of:


 * rheumatoid arthritis;


 * 1) usually symmetrical polyarthritis, DIP joints are rarely affected;
 * 2) palpably painful joints (synovitis), pain is at rest (in osteoarthritis, it is exertional);
 * 3) longer morning stiffness (more than an hour);
 * 4) inflammatory markers and immunological indicators (RA, antinuclear antibodies…);


 * psoriatic arthritis - when DIP is affected, psoriasis should be considered;
 * crystal-induced diseases - pseudogout episodes, chondrocalcinosis on X-ray, crystals in joint aspiration.

Forms of OA

 * Gonarthrosis - most common localization, progresses slowly;
 * Coxarthrosis - often after CDH or Perthes disease, usually intermittent course;
 * Osteoarthritis of hand joints - affecting DIP (Heberden's nodes), PIP (Bouchard's nodes), rhizarthrosis (thumb base joint);
 * Osteoarthritis of the spine - affecting vertebral bodies (spondylosis - osteophytes on the edges of vertebral bodies), intervertebral joints (spondylarthrosis), discs (discopathy), unlike spondylitis, pain is exertional and better at rest.

Treatment



 * 1) Regimen measures and rehabilitation, physical therapy;
 * 2) Pharmacological:
 * 3) *Analgesics paracetamol and nonsteroidal anti-inflammatory drugs (ibuprofen, diclofenac…);
 * 4) specific COX-2 inhibitors (nimesulide, coxibs);
 * 5) corticosteroids intra-articularly - no more than 3 times a year;
 * 6) *symptomatic slow-acting drugs in osteoarthritis (SYSADOA) - (hyaluronic acid, chondroitin sulfate, glucosamine sulfate…) - effect after 3 months, given in series;
 * 7) Surgical:
 * 8) *arthroscopic abrasion (lavage, synovectomy, debridement);
 * 9) *osteotomy;
 * 10) *partial or total joint replacement.

Prevention

 * Elimination of the cause in all secondary arthritis;
 * Screening for congenital hip dysplasia in newborns;
 * Limiting meniscectomies;
 * Correction of unequal leg length;
 * Treatment of synovitis;
 * Maintaining a healthy body weight;
 * Prevention of long-term unilateral overloading of certain joints;
 * In mild initial involvement (pre-osteoarthritis), movement, preferably swimming or cycling.