Osteoarthritis
Updates to Article Attributes
Body
was changed:
Osteoarthritis (OA) is the most common form of arthritis, being widely prevalent with high morbidity and social cost.
Terminology
Some authors prefer the term osteoarthrosis instead of osteoarthritis as some authors do not believe in an inflammatory cause as might be suggested by the suffix "itis". The condition is sometimes called non-erosive osteoarthritis, to differentiate it from erosive osteoarthritis, although this is considered a form of osteoarthritis 6.
Epidemiology
Osteoarthritis is common, affecting ~25% of adults 7. The prevalence increases with age. In the age group below 50 years men are more often affected, while in the older population the disease is more common in women. It is estimated that over 300 mln people in the world suffered from OA in 2017 13.
Clinical presentation
Patients present with decreased function from joint pain, instability and stiffness 7,10. The pain is typically worsened by activity and decreases at rest; in later disease stages it may become continuous 12. Many cases of radiological OA are asymptomatic and conversely clinically apparent OA may not manifest radiographic change 9,10.
Pathology
The pathogenesis and pathophysiology of OA are yet to be fully understood 7. Despite emphasis being placed on articular cartilage degeneration, the remainder of the joint is involved including bone remodelling, osteophyte formation, ligamentous laxity, periarticular muscle weakness and synovitis 8,10.
Distribution
OA can affect both the axial and appendicular skeleton. The most common peripheral joints affected include ref:
Risk factors
Strong risk factors for developing OA include 7,10:
- obesity
- increasing age
- female sex (particularly between
agesthe age 50-80and 80) - family history
Classification
Osteoarthritis can be:
-
primary/idiopathic/typical
- absence of an antecedent insult
- strong genetic component with the disease primarily affecting middle-aged women 5
-
secondary/atypical
- abnormal mechanical forces (e.g. occupational stress, obesity)
- previous joint injury
-
post-traumatic osteoarthritis
- accounts for ~12% of all OA 11
- major cause in young adults 9
- prior surgery
- crystal deposition (e.g. gout, CPPD)
- haemochromatosis
-
post-traumatic osteoarthritis
Radiographic features
Key radiographic features are joint space narrowing (JSN), sclerosis, and osteophytosis. If all three of these findings are not present, another diagnosis should be considered. Recently, with increasing use of MRI in the assessment of OA, other findings have been studied, such as bone marrow lesions and synovitis.
Joint-
joint space narrowing
- characteristically asymmetric
- least specific: present in many other pathological processes
Sclerosis
- sclerotic changes occur at joint margins
- frequently seen unless severe osteoporosis is present
Osteophytosis
- i.e. development of osteophytes
- common DJD finding
- will also be diminished in the setting of osteoporosis
- some osteophytes carry eponymous names, e.g. Heberden nodes, Bouchard nodes
Jointjoint erosions
- several joints may exhibit degenerative erosions 1:
- temporomandibular joint
- acromioclavicular joint
- sacroiliac joints
- symphysis pubis
Subchondral cystsubchondral cysts
- also known as
ageodegeodes - cystic formations that occur around joints in a variety of disorders, including, rheumatoid arthritis, calcium pyrophosphate dihydrate crystal deposition disease (CPPD) and avascular necrosis
.
- visible on MRI as bone marrow oedema-like lesions, often adjacent to areas of cartilage damage
- it is non-specific finding, present also in other diseases, including inflammatory and infectious conditions
- present in up to 50% of the patients with OA 14
- according to some authors it may be correlated with pain, disease severity and progression 14,15
Treatment and prognosis
There is no effective treatment to slow or reverse the changes of osteoarthritis 7. The mainstays of treatment include exercise, walking aids, bracing, and analgesia (including intra-articular steroid injections) 8. Arthroplasty can result in improved function and reduced pain 10.
-<p><strong>Osteoarthritis (OA) </strong>is the most common form of arthritis, being widely prevalent with high morbidity and social cost. </p><h4>Terminology</h4><p>Some authors prefer the term <strong>osteoarthrosis </strong>instead of osteoarthritis as some authors do not believe in an inflammatory cause as might be suggested by the suffix "itis". The condition is sometimes called <strong>non-erosive osteoarthritis</strong>, to differentiate it from <a href="/articles/erosive-osteoarthritis">erosive osteoarthritis</a>, although this is considered a form of osteoarthritis <sup>6</sup>. </p><h4>Epidemiology</h4><p>Osteoarthritis is common, affecting ~25% of adults <sup>7</sup>.</p><h4>Clinical presentation</h4><p>Patients present with decreased function from joint pain, instability and stiffness <sup>7,10</sup>. Many cases of radiological OA are asymptomatic and conversely clinically apparent OA may not manifest radiographic change <sup>9,10</sup>. </p><h4>Pathology</h4><p>The pathogenesis and pathophysiology of OA are yet to be fully understood <sup>7</sup>. Despite emphasis being placed on articular cartilage degeneration, the remainder of the joint is involved including bone remodelling, <a href="/articles/osteophyte-2">osteophyte</a> formation, ligamentous laxity, periarticular muscle weakness and <a href="/articles/synovitis">synovitis</a> <sup>8,10</sup>.</p><h5>Distribution</h5><p>OA can affect both the <a title="Osteoarthritis of the vertebral column" href="/articles/osteoarthritis-of-the-vertebral-column">axial</a> and appendicular skeleton. The most common peripheral joints affected include <sup>ref</sup>:</p><ul>- +<p><strong>Osteoarthritis (OA) </strong>is the most common form of arthritis, being widely prevalent with high morbidity and social cost. </p><h4>Terminology</h4><p>Some authors prefer the term <strong>osteoarthrosis </strong>instead of osteoarthritis as some authors do not believe in an inflammatory cause as might be suggested by the suffix "itis". The condition is sometimes called <strong>non-erosive osteoarthritis</strong>, to differentiate it from <a href="/articles/erosive-osteoarthritis">erosive osteoarthritis</a>, although this is considered a form of osteoarthritis <sup>6</sup>. </p><h4>Epidemiology</h4><p>Osteoarthritis is common, affecting ~25% of adults <sup>7</sup>. The prevalence increases with age. In the age group below 50 years men are more often affected, while in the older population the disease is more common in women. It is estimated that over 300 mln people in the world suffered from OA in 2017 <sup>13</sup>.</p><h4>Clinical presentation</h4><p>Patients present with decreased function from joint pain, instability and stiffness <sup>7,10</sup>. The pain is typically worsened by activity and decreases at rest; in later disease stages it may become continuous <sup>12</sup>. Many cases of radiological OA are asymptomatic and conversely clinically apparent OA may not manifest radiographic change <sup>9,10</sup>. </p><h4>Pathology</h4><p>The pathogenesis and pathophysiology of OA are yet to be fully understood <sup>7</sup>. Despite emphasis being placed on articular cartilage degeneration, the remainder of the joint is involved including bone remodelling, <a href="/articles/osteophyte-2">osteophyte</a> formation, ligamentous laxity, periarticular muscle weakness and <a href="/articles/synovitis">synovitis</a> <sup>8,10</sup>.</p><h5>Distribution</h5><p>OA can affect both the <a href="/articles/osteoarthritis-of-the-vertebral-column">axial</a> and appendicular skeleton. The most common peripheral joints affected include <sup>ref</sup>:</p><ul>
-<li>female sex (particularly between ages 50-80)</li>- +<li>female sex (particularly between the age 50 and 80)</li>
-</ul><h4>Radiographic features</h4><p>Key radiographic features are joint space narrowing (JSN), sclerosis, and osteophytosis. If all three of these findings are not present, another diagnosis should be considered.</p><h5>Joint space narrowing</h5><ul>- +</ul><h4>Radiographic features</h4><p>Key radiographic features are joint space narrowing (JSN), sclerosis, and osteophytosis. If all three of these findings are not present, another diagnosis should be considered. Recently, with increasing use of MRI in the assessment of OA, other findings have been studied, such as bone marrow lesions and synovitis. </p><ul>
- +<li>joint space narrowing<ul>
-</ul><h5>Sclerosis</h5><ul>- +</ul>
- +</li>
- +<li>sclerosis<ul>
-</ul><h5>Osteophytosis</h5><ul>- +</ul>
- +</li>
- +<li>osteophytosis<ul>
-</ul><h5>Joint erosions</h5><ul><li>several joints may exhibit degenerative erosions <sup>1</sup><ul>- +</ul>
- +</li>
- +<li>joint erosions<ul><li>several joints may exhibit degenerative erosions <sup>1</sup>:<ul>
-</li></ul><h5>Subchondral cyst </h5><ul>-<li>also known as a <a href="/articles/geode">geode</a>- +</li></ul>
- +</li>
- +<li>subchondral cysts <ul>
- +<li>also known as <a href="/articles/geode">geodes</a>
- +</li>
- +<li>cystic formations that occur around joints in a variety of disorders, including, <a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a>, <a href="/articles/calcium-pyrophosphate-dihydrate-deposition-disease-1">calcium pyrophosphate dihydrate crystal deposition disease (CPPD)</a> and <a href="/articles/avascular-necrosis">avascular necrosis</a>
- +</li>
- +</ul>
- +</li>
- +<li>bone marrow lesions <ul>
- +<li>visible on MRI as bone marrow oedema-like lesions, often adjacent to areas of cartilage damage </li>
- +<li> </li>
- +</ul>
- +</li>
- +<li>synovitis<ul>
- +<li>it is non-specific finding, present also in other diseases, including inflammatory and infectious conditions </li>
- +<li>present in up to 50% of the patients with OA <sup>14</sup>
- +</li>
- +<li>according to some authors it may be correlated with pain, disease severity and progression <sup>14,15</sup>
- +</li>
- +</ul>
-<li>cystic formations that occur around joints in a variety of disorders, including, <a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a>, <a href="/articles/calcium-pyrophosphate-dihydrate-deposition-disease-1">calcium pyrophosphate dihydrate crystal deposition disease (CPPD)</a> and <a href="/articles/avascular-necrosis">avascular necrosis</a>.</li>
References changed:
- 12. Sakalauskienė G & Jauniškienė D. Osteoarthritis: Etiology, Epidemiology, Impact on the Individual and Society and the Main Principles of Management. Medicina. 2010;46(11):790. <a href="https://doi.org/10.3390/medicina46110111">doi:10.3390/medicina46110111</a>
- 13. Kloppenburg M & Berenbaum F. Osteoarthritis Year in Review 2019: Epidemiology and Therapy. Osteoarthritis Cartilage. 2020;28(3):242-8. <a href="https://doi.org/10.1016/j.joca.2020.01.002">doi:10.1016/j.joca.2020.01.002</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/31945457">Pubmed</a>
- 14. Braun H & Gold G. Diagnosis of Osteoarthritis: Imaging. Bone. 2012;51(2):278-88. <a href="https://doi.org/10.1016/j.bone.2011.11.019">doi:10.1016/j.bone.2011.11.019</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22155587">Pubmed</a>
- 15. Guermazi A, Hayashi D, Roemer F et al. Severe Radiographic Knee Osteoarthritis – Does Kellgren and Lawrence Grade 4 Represent End Stage Disease? – the MOST Study. Osteoarthritis Cartilage. 2015;23(9):1499-505. <a href="https://doi.org/10.1016/j.joca.2015.04.018">doi:10.1016/j.joca.2015.04.018</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25929973">Pubmed</a>
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