1. JOINT SYNDROME
Osteoarthritis
Rheumatoid Arthritis
SLE
Gout

2. Osteoarthritis
 Osteoarthritis is a non-inflammatory,
degenerative condition of joints
Characterized by degeneration of articular
cartilage and formation of new bone i.e.
osteophytes.

3.  Common in weight-bearing joints such as hip
and knee.
 Also seen in spine and hands.
 Both male and females are affected.
 But more common in older women i.e. above
50 yrs,particularly in postmenopausal age.

4. Risk factors
 Obesity esp OA knee
 Abnormal mechanical loading eg.meniscectomy, instability
 Inherited type II collagen defects in premature polyarticular O
 Inheritance in nodal OA
 Occupation eg farmers
 Infection:Non-gonococcal septic arthritis
Hereditary
Poor posture
Injured joints

5. Ageing process in joint cartilage
Defective lubricating mechanism
Incompletely treated congenital
dislocation of hip

6. Classification of Osteoarthritis
1- Localized –Ankle / knee/ hip/ spine/
hands
2- Generalized
3- Erosive
4- Crystal associated OA
According to Nodules
1- Nodular (Haberden’s, Bouchard’s)
2- Non-Nodular

7. X-Ray Classification of OA
1- No Osteophytes / Minimal changes
2- Single osteophytes / Subchondrial sclerosis /
Widening
3- Significant narrowing, Multiple osteophytes
4- Narrowing osteophytes, Deformity, Ankylosis

8. According to Limitation of Activity
1- Patient is able to do physical activity
2- Moderate decrease of physical activity
3- Significant decrease of physical activity
4- Total Ankylosis and no activity

9. Clinical features of OA
 Pain
 Stiffness
 Muscle spasm
 Restricted movement
 Deformity
 Muscle weakness or wasting
 Joint enlargement and instability
 Crepitus
• Joint Effusion

10. Pain syndrome
•Morning stiffness <20 mins
•Pain is worst at the end of the day
•Present muscular spasms
•Inflammatory sinovits

11.  Movement abnormalities
 ‘Gelling’: stiffness after periods of
inactivity, passes over within minutes
(approx 15min.) of using joint again
 Coarse crepitus: palpate/hear (due to
flaked cartilage & eburnated bone ends)

12. Deformities
 Soft tissue swelling:
○mild synovitis
○small effusions
 Osteophytes
 Joint laxity
 Asymmetrical joint destruction
leading to angulation

13. Osteoarthritis of the DIP
joints. This patient has
the typical clinical
findings of advanced
OA of the DIP joints,
including large firm
swellings (Heberden’s
nodes), some of which
are tender and red due
to associated
inflammation of the
periarticular tissues as
well as the joint.

14. Knee joint effusion

15. Special Investigations
 Blood tests: Normal
 Radiological features:
 Cartilage loss
 Subchondral sclerosis
 Cysts
 Osteophytes

16. COMPLAINS
a. Patient complains of pain of
insidious onset in the knee
joints. The pain is aching and
poorly localized.
b. Pain first occurs after normal
joint use and can be relieved
by rest. As the disease
progresses, pain during rest
develops. Morning stiffness
lasts less than a half hour.
c. Systemic symptoms are
absent.

19. varus angulation
of the knee joints

21. Hallux valgus deformation

24. Varus angulation
of the knee joints

27. RESULTS OF ANALYSES
 CBA- without pathology
 CUA- without pathology
 CRP 3 mg/l
 Synovial fluid is
noninflammatory with less than
2000 white blood cells/mm3

28. OA-
Plus tissue diseas
(osteophytes)

39. X-ray of painful knee
joint

43. 
 PLAN OF
TREATMENT?

44. TREATMENT
A. Correction of predisposing factors
B. Patient education
C. Joint rest
1. Obesity. Weight reduction is important.
2. Malalignment. Valgus-varus knee deformity and
eversion-inversion ankle deformity may require
surgical correction.
3. Occupational changes may be necessary to protect
diseased joints.
D. Physical therapy
1. Therapeutic exercise.
2. Heat generally relieves pain and muscle spasm.
E. Occupational therapy

45. Drug therapy
• Analgesics
Acetaminophen
1. Nonsteroidal anti-inflammatory drugs
Choice of NSAID.
 Salicylates.
- Enteric-coated aspirin.
- Salsalate
 Indoleacetic acid.
 Oxicam.
 Propionic acid.
 Fenamic acid.
 Pyrazolone.

46. NIMESULIDE

47. Less than 3
days. For sharp
pain
LORNOXICAM

48. PATHOGENETICAL
THERAPY
Chondroprotection
 a) systemic - 1500mg atleast 1yr,
glucosamine, chondroitin sulfate, (most
slowly influencing drugs
 b) local- Intrarticular injections
(Hyaluronic acid, ) ), Traumeel, Alflutop)
(A joint should not be injected more than 3
times a year. Intraarticular corticosteroids have
an adverse effect on local car-tilage
metabolism. )

49. Surgery
1. Indications
a. Relief of pain or severe
disability after failure of
conservative measures to reverse
or alleviate the pathologic process.
b. Correction of mechanical
derangement that may lead to OA.

50. Contraindications
a. Infection.
b. Poor vascular supply.
c. Emotional instability or occupational
factors that make surgical rehabilitation
unlikely to succeed.
d. Obesity (relative contraindication).
e. Serious medical illness (relative
contraindication).
Knee procedures
a. Osteotomy.
b. Arthrodesis.
c. Total knee prosthesis.
d. Arthroscopic debridement.

51. Hip
a. Osteotomy.
b. Excision arthroplasty. .
c. Arthrodesis.
d. Total hip replacement

52. Joint replacement surgery (arthroplasty)

54. THANK YOU
Manj -2012 KSMU