Osteoarthritis
- Osteoarthritis is the commonest condition affecting synovial joints
- No longer considered simple joint 'wear and tear'
- Change in cartilaginous matrix is probably important
- Primary OA is of unknown aetiology
- Secondary OA is the result of congenital, infective joint disorders
or trauma
- Pathology characterised by:
- Loss of hyaline cartilage
- Subchondral bone sclerosis
- Subchondral cyst formation
- Osteophyte formation
- Several patterns of joint involvement recognised including:
- Generalised nodular OA
- Large joint osteoarthritis
Clinical features
- Joint pain - worse after exercise or at end of day
- Pain relieved by rest
- Limited early morning stiffness
- Limited stiffness after rest
- Bony joint swelling
- Few systemic features
Management
- Aims of treatment are to:
- Reduce joint pain
- Improve joint function
- In early stages pain can often be improved with simple analgesia
- Life style modification is also important
- NSAIDs can often help
- Intra-articular steroids can reduce symptoms
- If fails to improve with conservative measures surgery may be
required
- Surgical options for degenerative joints are
- Arthroscopic lavage and debridement
- Osteotomy - alteration of joint alignment
- Arthroplasty - replacement of diseased joint
- Arthrodesis - fusion of disease joint
Rheumatoid arthritis
- Rheumatoid arthritis is an autoimmune inflammatory synovial disease
- Aetiology if unknown
- Worldwide prevalence is approximately 1%
- Female : male ratio is 3:1
- Onset most often seen between 20 and 40 years
- Usually symmetrically affects multiple joints
- Commonest joints affected are hand, elbow, knee and cervical spine
- Also affects synovium of tendon sheaths
- Often part of a systemic inflammatory process
- More common in those with HLA DR4 and DW4
- Pathologically characterised by:
- An inflammatory process within the synovium
- Joint destruction and pannus formation
- Periarticular erosions
Clinical features
- Joint pain - worse during exercise
- Pain relieved by movement
- Prolonged early morning stiffness
- Prolonged stiffness after rest
- Marked soft tissue swelling and erythema
- Systemic features often present
Extra-articular manifestations
Occur in approximately 20% of patients
- Ocular
- Keratoconjunctivitis sicca
- Episcleritis
- Scleritis
- Pulmonary
- Pulmonary nodules
- Pleural effusion
- Fibrosing alveolitis
- Cardiac
- Pericarditis / pericardial effusion
- Valvular heart disease
- Conduction defects
- Cutaneous
- Palmar erythema
- Rheumatoid nodules
- Pyoderma gangrenosum
- Vasculitic rashes and leg ulceration
- Neurological
- Nerve entrapment
- Cervical myelopathy
- Peripheral neuropathy
- Mononeuritis multiplex
Management
- Requires a multidisciplinary approach
- Disease modifying drugs include:
- NSAIDs
- Methotrexate, sulphasalazine, penicillamine, gold
- Corticosteroids
- Cytotoxic drugs
Specific syndromes
- Several syndromes have been described associated with rheumatoid
arthritis
- Felty's syndrome
- Rheumatoid arthritis
- Neutropenia
- Lymphadenopathy
- Splenomegaly
- Still's disease
- Rheumatoid arthritis in childhood
- Rash
- Fever
- Splenomegaly
- Sjogren's syndrome
- Rheumatoid arthritis
- Reduced lacrimal and salivary secretion
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Haq I, Murphy E, Dacre G. Osteoarthritis.
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Hunter D J, Felson D T. Osteoarthritis. BMJ
2006; 332: 639-342
Scott D L. Advances in the medical management of rheumatoid
arthritis. Hosp Med 2002: 63: 294-297.
Walker-Bone K, Javaid K,
Arden N, Cooper C.
Medical management of osteoarthritis.
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