Osteoarthritis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Osteoarthritis / Osteoarthrosis (OA, also known as degenerative arthritis, degenerative joint disease, arthrosis or in more colloquial terms "wear and tear") is the most common form of arthritis, caused by wearing of the cartilage that covers and cushions joint spaces. As the cartilage wears away, the patient experiences pain with weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. The word is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation. OA possesses a great degree of variability in disease onset, progression, and severity.
OA affects nearly 21 million people in the United States, accounting for 25% of visits to primary care physicians, and half of all NSAID (Non-Steroidal Anti-Inflammatory Drugs) prescriptions. It is estimated that 80% of the population will have radiographic evidence of OA by age 65, although only 60% of those will be symptomatic.[1] Treatment is with NSAIDs, local injections of glucocorticoid or hyaluronan, and in severe cases, with joint replacement surgery. Many physicians have also reported good pain relief by treating ligaments (which connect bone to bone) with Prolotherapy. There has been no cure for OA, as cartilage has not been induced to regenerate. However, if OA is caused by cartilage damage (for example as a result of an injury) Autologous Chondrocyte Implantation may be a possible treatment. Clinical trials employing tissue-engineering methods have demonstrated regeneration of cartilage in damaged knees, including those that had progressed to osteoarthritis.[2] Further, in January 2007, Johns Hopkins University was offering to license a technology of this kind, listing several clinical competitors in its market analysis.
While osteoarthritis of any joint is theoretically possible, the most common joints affected are the knees and hips given the degree of weight bearing required of these joints. Other joints, such as the distal interphalangeal joints of the fingers and shoulder joints are commonly affected as well.
Historical Perspective
The earliest descriptions of OA were provided by Heberden and Haygarth in the 19th century. [3] [4] In the 1930s and 1940s, Dr. Stecher showed that there were two forms of OA, idiopathic and post-traumatic. [5] Surgical management of OA was developed in the 1960s by Drs. Charnley and McKee. [6] [7]
Classification
Osteoarthritis is radiographically classified depending on what joint is affected.
Knee
Kellgren-Lawrence Grade
| Grade | Description |
|---|---|
| 0 | No radiographic features of osteoarthritis, normal joint space |
| 1 | Subtle joint space narrowing and osteophyte formation (bone spurs) |
| 2 | Definite osteophyte formation with subtle joint space narrowing |
| 3 | Multiple osteophytes, definite joint space narrowing, subcondronal sclerosis and possible bony deformity |
| 4 | Large osteophytes, marked joint space narrowing, severe subcondronal sclerosis and definite bony deformity |
Pathophysiology
Causes
Differentiating Osteoarthritis overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Routine screening for osteoarthritis is not indicated unless the patient is symptomatic.
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
References
- ↑ Green GA. Understanding NSAIDS: from aspirin to COX-2. Clin Cornerstone 2001; 3:50-59. PMID 11464731.
- ↑ Hollander AP, Dickinson SC, Sims TJ; et al. (2006). "Maturation of tissue engineered cartilage implanted in injured and osteoarthritic human knees". Tissue Eng. 12 (7): 1787–98. doi:10.1089/ten.2006.12.1787. PMID 16889509.
- ↑ Heberden W. Commentaries on the history and causes of disease. London: Payne; 1802.
- ↑ Haygarth J. A clinical history of diseases. II. Nodosity of the joints. London: Gadell and Davies; 1805.
- ↑ Stecher RM. Heberden’s nodes: heredity in hypertrophic arthritis of the finger joints. Am J Med Sci 1941:201;801–809.
- ↑ Charnley J. Arthroplasty of the hip: a new operation. Lancet 1961;1:1129–1132.
- ↑ McKee GK,Watson-Farrar J. Replacement of arthritic hips by the McKee-Farrar prosthesis. J Bone Joint Surg Br 1966;48(2):245–259.