Osteoarthritis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2].
Overview
Natural History
The orthopedic surgeons are frequently asked by their patients regarding the final outcome and the prognosis of their diseased joint/joints caused by OA. Information about the natural history of OA is very important for upcoming determinations and planing for patients management. Small number of studies are available studied the roll of the radiographic findings, joint congruence, or even the daily life activity on the OA progression.
Hip OA
Its been reported that the patients with unilateral idiopathic hip OA are most likely to develop OA in the contralateral hip. In a 10 years expectancy, the frequencies of OA development and undergoing the total hip total hip replacement (THR) among the contralateral hips considered as normal are 35-45% and 5-20%, respectively. Therefore, due to the importance of this topic and lack of confidential information in this regard, a long-term longitudinal study is needed in order to answer this big question that how often and how long does takes for symptomatic joint injury and requirement of surgical involvement in this regard. Meanwhile, the incidence and prevalence rates of THR in hip OA were 2.5% and 17%, respectively.
Knee OA
Based on the radiological evaluation of knee OA , the incidence rate of knee OA was 2-4% annually and this incidence rate was higher among women. The most importantly its been reported that the incidence rate of OA in radiography evaluations were twice higher than symptomatic OA which highlights the roll of radiography in this regard. In a cohort study, the OA progression in a 3-year evaluation reported to be 15.5%.
Hand OA
The hand as the most common and important peripheral site of osteoarthritis (OA), because the hand involvement in OA could affect patients life through disability. Meanwhile, the base of the thumb, and distal interphalangeal joints (DIPs), proximal interphalangeal joints (PIPs) of fingers are the most common site for hand OA. The prevalence of hand OA among men and women older than 65 years is 64-78% and 71 to 99%, respectively.
Complications
OA is a leading cause of morbidity having a significant effects on patients life and the health care system and even it could cause heavy economic burden. According to the American Academy of Orthopedic Surgeons report: movement limitation found in 80% of adults diagnosed with osteoarthritis. Meanwhile, 25 % of these patients facing difficulties in their of daily living activities which 11% of them need personal care assistance and 14% required help with their routine needs.
Unfortunately, despite of high prevalence and influence of OA on human life, there is only a limited studies working on the complications caused by OA. Possible complications of osteoarthritis include:
- Gout.
Gout is known as an inflammatory form of arthritis caused by high amount of urate leading to sodium urate crystals formation around the involved joints. Meanwhile, osteoarthritis by affecting the cartilage system can trigger the crystal formation specially in cases with higher serum levels of urate. Since the in foot osteoarthritis the big toe is a common site for involvement it could be considered as a common site of the occurrence of gout.
- Chondrocalcinosis.
Osteoarthritis can also leads to calcium pyrophosphate crystals formation in diseased cartilage. This is process named calcification or chondrocalcinosis. chondrocalcinosis can be developed in any joint, with/without existence of osteoarthritis. But, in patient with osteoarthritis, chondrocalcinosis is common in knee .
- Long-term (chronic) pain
- Rapid, complete breakdown of cartilage resulting in loose tissue material in the joint (chondrolysis).
- Joint deformities (hard or bony nodules that form where two bones come together, often giving the joint a knobby or knotted appearance)
- Bone death (osteonecrosis).
- Stress fractures (hairline crack in the bone that develops gradually in response to repeated injury or stress).
- Muscle weakness (often occurs when a joint becomes too painful to use, especially with knee osteoarthritis)
- Bleeding within the joint.
- Infection in the joint.
- Deterioration or rupture of the tendons and ligaments around the joint, leading to loss of stability.
- Pinched nerve (in osteoarthritis of the spine).
- Depression
- Anxiety
- Sleep disruption
- Weight gain
- Difficulty performing daily activities and Reduced productivity
- Loss of independent living
- Impaired balance
- Increased risk of falling
Prognosis
- Most osteoarthritis cases do stabilize.
- Some osteoarthritis cases progress.
- A small number of osteoarthritis patients improve spontaneously.