Osteoarthritis

//Western Diagnosis//
Degenerative Joint Disease Disorder of hyaline cartilage and subchondral bone

A. Collagen & elastic fibers in chondroitin sulate with chondrocytes B. Collagen: Protein fibers - most abundant protein in the body - strength C. Elastic: Protein fibers (elastin) - stretching D. Chondroitin Sulfate -Proteoglycans & glycosaminoglycans -Jelly-like substances that provide support and adhesiveness E. Chondrocytes: Cells of mature cartilage
 * Hyaline Cartilage:**

A. Asym in 2nd & 3rd decades - universal by age 70 Almost all by age 40 have pathologic changes in weight-bearing joints but few symptomatic Men & women equally affected by earlier onset in men
 * Most common of articular disorders:**

Primary & Secondary: PIP & DIP, 1st carpometacaral joint, cervical & lumbar spine, 1 m-p joint, hip, knee, disc & joints in spine (zygapophyseal)

Etiology
- Unknown but complex interaction of all cellular processes -Anything that changes the environment of the chondrocyte -Congenital, infectious, metabolic, endocrine, neuropathic, any disease that affects the structure and function of hyaline cartilage, trauma

Pathophysiology:
1. Hyaline cartilage is avascular, aneural, alymphatic 2. Chondrocytes have longest cell cycle in body 3. Pumping action of weight bearing and use 4. Initial event is mitosis of chondrocyte from some change in environment 5. Increased synthesis of subchondral bone 6. Stiffer - microfractures - callus 7. Metaplasia of peripheral synvial cells: osteochondrophytes around joint 8. Pseudocysts in marrow below subchondral bone 9. Roughening, ulceration, loss of hyaline cartilage 10. Proliferation of structural elemets of joint 11. Remodeling of joint surface

Signs & Symptoms
1. Subtle gradual onset in one or a few joints 2. Pain 3. Stiffness after inactivity feels better in less than 15-30 minutes, better with exercise 4. Decreased joint motion 5. Flexion contractures 6. Tenderness, crepitus 7. Enlarged joint: Heberden's nodes at DIP joints; Bouchard's nodes at PIP joints 8. Joint instability - ligamentous laxity 9. Pain on passive motion 10. Muscle spasm

Diagnosis
1. Clinical 2. Imaging: Radiology -Irregular narrowing of joint space -Increased density of subchondral bone -Osteophytes -Pseudocysts 3. Lab -ESR - N, slightly increased -rule out other diseases

Treatment
1. Patient education 2. Exercise: ROM, postural, strengthening, stretching 3. Use 4. Rest 5. Drugs -NSAIDS (very common side effect of gastric bleeding) -Possibly muscle relaxants, antidepressants - No Corticosteroids - Least important aspect of treatment 6. Glucosamine SULFATE: 500mg. TID