The Detergents And Disinfectants For Instruments And Surfaces (Hexanios - Surfanios)

• Osteoarthritis (OA) is the most common arthritis (non-inflammatory) in the community.

• OA is not just cartilage damage; It is a painful degenerative process characterized by progressive deterioration of all joint structures and subchondral bone remodeling.

• The incidence of OA increases with age. It is rare under the age of 40, the prevalence is quite high above the age of 60. However, it can also be seen at an earlier age in the presence of underlying facilitating factors (secondary osteoarthritis).

• Secondary OA factors not only lead to the early onset of the disease, but also involve joints that are not expected to be involved in primary OA.

• Joints that are frequently expected to be involved in primary OA;

o in hand

Distal interphalangeal, Proximal interphalangeal, 1. Carpometacarpal

o In the axial skeleton

Cervical and lumbar vertebrae

o In the lower extremity

Hip, Knee, 1st Metatarsophalangeal

Distal interphalangeal joint involvement

psoriatic arthritis

osteoarthritis

pathophysiology

• Cartilage damage and consequent remodeling of subchondral bone; subchondral cysts, subchondral sclerosis and osteophytes develop.

pathogenic factors

• Aging is the most potent risk factor for the development of OA.

• (biomechanical) factors causing asymmetrical load distribution in the joint; joint damage, joint developmental disorder, joint instability etc.

• Metabolic factors; alkaptonuria, acromegaly, hemochromatosis

• Obesity

• Patients with increased bone density are at risk for OA.

• Doing repetitive tasks (Ex: Professional runners have an increased risk of knee and hip OA)

Clinical Findings

• The most obvious complaint is pain.

o The source of the pain is the joint elements other than the cartilage. Because cartilage tissue has no innervation.

o The severity of radiological joint involvement is not correlated with the severity of pain.

o Pain; It becomes evident with the use of the joint and partially decreases with rest. As time passes, the pain becomes continuous and begins to be felt at rest.

• Although morning stiffness can be clearly felt in some patients, it lasts less than half an hour.

• Movement restriction, locking and "squeaky" feeling may occur in the joint.

• Hand joints

o DIF joints are most commonly involved.

o Bony prominences in the DIF joint, Heberden's nodules; The bony prominences in the PIF joint are called Bouchard's nodules.

• knee joint

o OA is the most common cause of chronic knee pain in patients over 45 years of age.

• Foot joints

o The tightest. The MTF joint is involved. Joint thickening and hallux valgus deformity develop.

• Primary OA typically; MCP does not involve wrist, elbow, ankle and tarsal joints. If there is involvement of these joints, underlying facilitating causes (secondary OA) should be sought.

physical examination

• OA is not a true inflammatory arthritis. For this reason, redness or increase in temperature is usually not expected.

• Since the joint surface is rough and rough, crepitation can be taken with joint movement.

• Osteophytes can be palpated, free particles detached from the joint surface may lock, especially in the knee joint (joint mouse, loose body).

laboratory findings

• Acute phase reactants and complete blood count are usually normal, no specific autoantibody positivity is expected.

• The synovial fluid total cell count is generally less than 1500-2000/mm3.

Radiological findings

• Typical findings that can be seen radiographically;

o Asymmetric narrowing of the joint space

o Subchondral cysts and subchondral sclerosis

o New bone formation (osteophytes)

Treatment

• The main goals of treatment are pain palliation and reduction of physical function loss.

• Nonpharmacological treatment

o Focal load on the joint should be reduced

o Weight loss should be recommended.

• Pharmacotherapy

o Acetaminophen is primarily the analgesic of choice.

o NSAIDs are the most popular drugs for treating OA pain.

o Topical capsaicin can also be used.

o Intra-articular glucocorticoid injections may be considered when pain is intense.

o In the presence of pain that does not respond to these treatments, opioid analgesics and duloxetine may also be tried.

o Recent guidelines do not recommend the use of chondroitin and glucosamine.

• Surgical treatment

o When medical treatment options are exhausted, total joint replacement surgery is recommended for the treatment of knee and hip OA.

o The presence of advanced degeneration of the joints alone without severe symptoms should not be an indication for surgery.