osteoarthritis

• Osteoarthritis


  A type of arthritis characterized by the breakdown and eventual loss of the cartilage of one or more joints
• Risk factors for osteoarthritis

  • Age
  • Female gender
  • Obesity
  • Biomechanical abnormalities
  • Occupation
  • Sports activities
  • Previous injury
  • Muscle weakness
  • Decreased proprioception
  • Genetics
  • Pseudogout (calcium phosphate deposition)
• Obesity


  A risk factor for osteoarthritis in the knee and hand, but not the hip
• Occupations associated with osteoarthritis

  • Farm work
  • Shipyard work
  • Carpentry (hand/hip OA in physical laborers)
  • Repetitive knee bending (knee OA)
• Previous injuries associated with osteoarthritis

  • Knee ligament injury
  • Hip dislocation
  • Rotator cuff tear
  • Articular fractures leading to post-traumatic arthritis
• Anatomical abnormalities that increase joint stress

  • Bow-legged
  • Knock-kneed
  • Congenital hip disorders (SCFE, LCP)
• Age


  A risk factor due to thinning of articular cartilage, decreased cartilage hydration, accumulation of glycated proteins/CCP, and inhibition of anabolic factors
• Subjective findings in osteoarthritis

  • Slowly progressing pain
  • Pain of varying intensity, increased with use
  • Posterior knee pain with severe OA
  • Stiffness after sleep/inactivity
  • Effusion (enlarged without effusions due to synovial hypertrophy/osteophyte formation)
• Physical exam findings in osteoarthritis

  • Deformities
  • Anatomic abnormalities (nodes, limb shortening, valgus/varus alignment)
  • Effusion
  • Joint line tenderness
  • Periarticular tenderness
  • Decreased active/passive range of motion
  • Crepitus of superficial joints
  • Assess ligamentous laxity
• Hip osteoarthritis symptoms/signs


  • Groin pain/ache/stiffness/restricted range of motion (pain with starting movement from chair/walking)
  • Restricted movement (pain with internal rotation/hip flexion)
  • Pain radiates to anterior thigh but NOT under knee
  • Shortened limb
  • Thigh muscle atrophy
  • Trendelenburg gait
• Make sure to rule out avascular necrosis in hip osteoarthritis
• xrays in osteoarthritis show joint space narrowing
• Knee osteoarthritis symptoms/signs


  • Bilateral with one side worse
  • Pain/tenderness indicates affected area (medial patellofemoral most common)
  • Pain worse with sitting, standing from low chair, descending stairs
  • Posterior knee pain unless Baker's cyst
  • Joint line tenderness
  • Effusion
  • Patellofemoral crepitus
  • Pseudolaxity
  • Flexion contracture
• Osteoarthritis treatments


  • Weight loss
  • Rest
  • Physical therapy
  • Orthoses (footwear, braces, ambulatory aids)
  • Supplements
  • Heat/cold
  • Psychosocial support
  • Acetaminophen
  • NSAIDs, maybe COX-2 inhibitors
  • Opioids
  • Glucocorticoids
  • Hyaluronic acid
  • Surgery
• Reactive arthritis (Reiter's syndrome)


  A type of arthritis that develops after an infection elsewhere in the body
• Risk factors for reactive arthritis

  • HIV
  • Chlamydia
  • Yersinia
  • Salmonella
  • Shigella
  • Campylobacter
• Symptoms/signs of reactive arthritis

  • Acute arthritis
  • Enthesitis (pain/swelling, local tenderness at insertion of ligament/tendon/joint capsule)
  • Dactylitis (sausage digits)
  • Low back pain
  • Conjunctivitis
  • Uveitis
  • Genitourinary tract symptoms
  • Oral lesions
  • Skin lesions on palms/feet
  • Nail changes
  • Genital lesions
• Diagnostic criteria for reactive arthritis

  • Musculoskeletal findings
  • Evidence of prior infection away from infected joints
  • Lack of evidence to support a different cause
• Reactive arthritis is a diagnosis of exclusion
• Labs in reactive arthritis show prior/concurrent infection, elevated ESR/CRP, positive HLA-B27, and aseptic inflammatory synovitis
• Radiographs in reactive arthritis show nothing