Osteoarthritis
Ioannis Raftakis
Osteoarthritis (OA) is a degenerative, progressively evolving disease of the hands, knees, hips and spine. According to the definition of the World Health Organization OA is the result of mechanical and biological causes, which result in the disturbance of the balance between synthesis and degradation of the articular cartilage and the subchondral bone.
The frequency and severity of OA is affected by:
- Advancing age
- Gender—increased incidence in women
- Genetic factors
- Obesity
- Injuries
- Congenital anomalies
- Symptoms
The most frequent symptom of OA is pain mainly on exertion. It may be accompained by joint stiffness as well as joint swelling.
Imaging
Plain x-rays are the simplest and most economical way of imaging. Narrowing of the intraarticular space, hardening of the subchondral bone and formation of osteophytes are characteristically observed.
Ultrasound. In recent years, musculoskeletal ultrasound (US) has been used not only in diagnosing and monitoring of inflammatory diseases, but also of degenerative ones. With this technique, it is possible to visualize the articular cartilage of large peripheral joints such as the knee, hip, shoulder, but also of the small joints of the extremities of the hands and feet. It is also possible to detect small synovial effusions or membrane hypertrophy in cases of inflammatory osteoarthritis, as well as osteophytes, with greater sensitivity than radiographs. Additionally, US can reveal pathological findings in soft peri-articular tissues (tendons, ligaments), the pathology of which can worsen the patient’s symptoms.
Finally, advantages of ultrasound are the ability to check multiple joints and soft tissue structures in one single examination, the absence of ionizing radiation and the possibility of dynamic examination to detect collection of fluid in small joint. The aforementioned reinforces the view of using ultrasound as a first-line imaging examination for osteoarthritis.
Computed Tomography is mainly used to detect lesions in the spine. The increased radiation is sometimes an inhibiting factor.
Magnetic resonance is the most specific diagnostic test for detection of lesions that are not visible by the other techniques, such as meniscal tears. Increased cost, long examination time and claustrophobia can be inhibiting factors.
Bone scan can be used for differentiation between inflammatory or degenerative diseases.
Treatment
The treatment is divided into pharmaceutical and non-pharmaceutical. The role of drugs is to reduce pain and improve function. These can be topical creams, simple analgesics, anti-inflammatories, slow-acting anti-osteoarthritics (glucosamine, turmeric extracts), as well as hyaluronic acid or corticosteroid injections. In non-pharmacological actions, physical exercise and physical therapy have good results. In final stages and if conservative means are not effective, surgical treatment is preferred as a final solution.
Bibliography:
- Kuettner KE et al: American Academy of Orthopaedic Surgeons Symposium.In Osteoarthritic disorders. Rosemont: AOS publishers 1994
- Johnson VL et al. The epidemiology of osteoarthritis Best practice and Res Clin Rheum 2014; 28: 5-15
- Hawker GA et al. Understanding the pain experience in hip and knee osteoarthritis- an OARSI/OMERACT Osteoarthritis Cart 2008; 16: 415-22
- Abraham AM et al. Population prevalence of ultrasound features of osteoarthritis in in the hand, knee and hip at age 63. BMC Musculoskel Dis 2014; 15: 162-70