Osteoarthritis

Definition/Description[edit | edit source]

Prior to 1986, the definition for osteoarthritis was: "Osteoarthritis, or degenerative arthritis, is a heterogeneous group of conditions that lead to joint symptoms and signs which are associated with degeneration of articular cartilage, in addition to related changes in the underlying bone and at the joint margins.[1] " (Level of evidence: A1)
Osteoarthritis has known many other definitions by time until a more recent definition was issued by Kuttner et al[2], in 1994 and reads as follows: "Osteoarthritis is a group of overlapping distinct diseases, which may have different etiologies but with similar biologic, morphologic, and clinical outcomes. The disease processes not only affect the articular cartilage, but involve the entire joint, including the subchondral bone, ligaments, capsule, synovial membrane, and periarticular muscles. Ultimately, the articular cartilage degenerates with fibrillation, fissures, ulceration, and full thickness loss of the joint surface." (Level of evidence: A1)

Epidemiology /Etiology[edit | edit source]

Epidemiology[edit | edit source]

As highlighted by Peyron[3], one adult on three has osteoarthritis and above 55 years, this disease has a prevalence of 4 times more than the total population. Professionals in collaboration[4] mentioned that people from the United States and black people from Jamaica and Africa has the highest prevalence. Further on, woman has a higher prevalence as well. Race- and gender differences are more clearly than climatic differences.

Allander et al.[5] approved that age has an influence on the severity of osteoarthritis at the level of hands and feet. This proves the relation between age and gender with osteoarthritis. Further on, research from Kelsey et al.[6] proved that arthritis and musculoskeletal diseases are the most common chronic diseases and causes of physical disability in the United States.

Etiology:[edit | edit source]

We can make out two forms of osteoarthritis[4](Level of evidence: A1):

Primary osteoarthritis[edit | edit source]

This is the form of osteoarthritis in which you don't know what could trigger the disease. You can't infer anything from history, nor clinical or radiographic examination.

Secondary osteoarthritis[edit | edit source]

This last form can be caused by trauma, metabolic disease, congenital malformations, premature menopause, etc. Sometimes, it can happen that a patient is suffering from secondary osteoarthrits before the age of 40.

Characteristics/Clinical Presentation[edit | edit source]

Clinical signs depend mainly to the affected joint but usually, they show some common characteristics. They're mainly local. Symptoms are[4]:

  • Pain:
    This is a 'mechanical' type of pain which is generated by mobilization, increases with fatigue and decreases with rest. Pain occurs in the morning or after a period of inactivity. Mostly, there's no overnight pain. The intensity of pain is variable. Sometimes it's dull and tolerable, other times it's very heavy with short peaks. It can be stimulated by cold, trauma and fatigue.
    This pain occurs at the level of the subchondral bone and in capsuloligamentar and muscular structures.
  • Limition in movement (loss of ROM):
    Limitation in movements expires insidious, progressive and  will be noticed after several years. This limitation is mainly related to the blocking of voluntary muscle functioning and the reflexcontracture. It's also the result of changes in the articular spaces, with incongruention of  joint surfaces. Some patients complain about stiffness in the morning, which holds on for a longer period but is less severe than the morningstiffness from rheumatoid arthritis or ankylosing spondylitis. In most of the patients the limitation in movement is progressive. The severity increases with time and is accompanied with the joint deformities and wear of the cartilage.
  • Sounds: 
    The sounds you can hear are cracking, scraping and sounds from crepitation. They're generated by mobilization of the joint. You can even hear them when you palpate the joint. Irregularities in the articulating joint surfaces and poor quality of the remaining cartilage is very likely to be the cause.
  • Difficult and painful mobilization:
    It's important to differentiate between total blocking and limited mobility, due to immobilization for a longer period. Total blocking is caused by the presence of meniscus, unusual structures, etc.
  • Morphological deformities:
    The affected joint is only in a few cases red and feels warm. Normally, it has a normal color and temperature. The increase in volume is due to changes in ratio between the joint surfaces. There may also be moisture in the arthritic joint, caused by irritation, mechanical and/or biochemical phenomena at the synovial membrane.

There are no biological characteristics of osteoarthritis. There are no inflammatory signs nor immunological disorders or abnormalities of phosphocalium metabolism.

Differential Diagnosis[edit | edit source]

Osteoarthritis is a degenerative process at the level of the cartilage and should be well distinguished from arthritis, where it’s about a synovial inflammatory process[4].

Abrasive, scraping sensations of the patella during mobilization of the knee joint can also occur in patients with Chondromalacia Patellae, with preservation of the articular cartilage.

Diagnostic Procedures[edit | edit source]

The severity of osteoarthritis can be evaluated by radiography, according the Kellgren[7]. By this way, we can discriminate four degrees of severity in osteoarthritis:
Degree I: normal joint with a minimal osteophyte.
Degree II: osteophytose on two points with minimal subchondral sclerosis, proper joint space and no deformity.
Degree III: moderate osteophytose, early deformity of the bone endings and a joint space which narrows.
Degree IV: large osteophytes, deformity of bone endings, narrowing joint space, sclerosis and cysts.

Outcome Measures[edit | edit source]

  1.  Western Ontario and McMaster universities osteoarthritis index (WOMAC) WOMAC_Osteoarthritis_Index,
  2. The algofunctional index (AFI) [[]] and
  3. The intermittent and constant osteoarthritis pain index(ICOAP) Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Therapy Management[edit | edit source]

OA causes reduced muscle strength (particularly in those muscles around the affect joint), decreased flexibility, weight gain, limitation in the ability to do ADL-activities and often compromised mobility. Increased physical and psychological function and an increased feeling of well-being are the main goals of an integrated exercise program. Increased joint motion, enhancing muscle strength, increased aerobic capacity and optimal body weight are immediate objectives.[9](Level of evidence: D)[10] (Level of evidence: A1)

Basic Therapy Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title(Level of evidence: A1)  [10](Level of evidence: A1)  (Not for patients with acute painful joint swelling and cardiovascular diseases.)

  • Warm-up and range of motion[9](Level of evidence: D)
  • Strengthening (quad sets,supine straight leg raises, prone hip extensions, seated isometric knee extensions, single-leg leg presses,standing hamstring curls, and standing heel raises)
  • Aerobic program[9](Level of evidence: D)
  • Cooling down with muscle stretching (quadriceps femoris, hamstring, and calf muscle stretching) 
  • Long-sitting knee flexionand extension range of motion, and treadmill walking.
  • All lower-extremity exercises need to be performed bilaterally.

Agility and Perturbation TrainingTechniquesCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  (Level of evidence: A2) 

Agility techniques:

  • Side stepping
  • Braiding (lateral stepping combined with forward and backward crossover steps)
  • Front crossover steps during forward ambulation
  • Back crossover steps during backward ambulation
  • Shuttle walking(forward and backward walking to and from designated markers)
  • A drill requiring multiple changesin direction

Perturbation techniques: ( Level of evidence: A2)

Resources
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NICE guidelines

Recent Related Research (from Pubmed)
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References
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  1. ALTMAN et al. 'Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee'. Arthritis Rheum, 1986; 3: 1039 - 1049.
  2. KUTTNER J.H., GOLDBERG V.M. 'Osteoarthritic Disorders'. American Academy of Othopaedic Surgeons, 1995; Rosemont xxi - v.
  3. Article: PEYRON J.G. ‘Epidemiologic and etiologic approach of osteoarthritis.’ Seminars in Arthritis and Rheumatism, 1979; 8: 288-306.
  4. 4.0 4.1 4.2 4.3 Book: CRIELAARD J.M., DEQUEKER J., FAMAEY J.P., FRANCHIMONG P., GRITTEN Ch., HUAUX J.P. et al. ‘Osteoartrose’. Brussel, België: drukkerij Lichtert; maart 1985.
  5. Article: ALLANDER E. 'Rheumatology in perspective. The epidemiological view. Scand. J. Rheum.; 1982: Suppl. 46, 49.
  6. KELSEY J.L., HOCHBERG M.C. 'Epidemiology of chronic musculoskeletal disorders'. Ann Rev Public Health, 1988; 9: 379-401
  7. Book: KELLGREN J.H. 'Atlas of standard radiographs of arthritis'. Volume II of The Epidemiologic of Chronic Rheumatism. Oxford, Blackwell, 1963.
  8. I B de Groot , M Reijman , C B Terwee , S Bierma-Zeinstra , M M Favejee , E Roos and J A Verhaar; Validation of the Dutch version of the Hip disability and Osteoarthritis Outcome Score ; Osteoarthritis and Cartilage : 2009 Vol. 17, num. 1 , pp. 132
  9. 9.0 9.1 9.2 Book: McCarty et al. 'Arthritis and allied conditions'. Lea &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Febiger, Philidelphia, London, 1993.
  10. 10.0 10.1 KNGF-guidline, osteoarthritis of the hip and knee. https://www.kngfrichtlijnen.nl/downloads/Osteoarthritis_of_the_hip_and_knee_V06-2010_PRL_ENG.pdf