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Osteoarthritis

Osteoarthritis (OA)
Degenerative joint disease
disease of the entire joint involving the
cartilage, joint lining, ligaments, and
underlying bone

Osteoarthritis

Cartilage: function
Enable movement within the required
range of motion
Distribute loading across joint tissues
Stabilize the joint during use

Pathologic changes in OA

Arthritis VS healthy joints

Classification of OA
1. Primary (Idiopathic OA)
Most common
Age >50 years, women > men
2. Secondary OA
Occupation, sport, trauma
Obesity
Inflammatory joint disease (RA, gout)

Distribution of primary OA

Risk factors of osteoarthritis

Older age
Family member with OA
Obesity
Previous traumatic injury or repetitive
use of joints
Joint deformity such as unequal leg
length

Signs and symptoms

Joint pain and stiffness
Cracking or grinding noise with joint
movement
Swelling or tenderness in one or more
joints
Decreased function of the joint

Diagnosis of OA (knee)

Diagnosis of OA (hip)

Diagnosis of OA (hand)

Goals
Educate the patient, family members
and caregiver
Relieve pain and stiffness
Maintain or improve joint mobility
Limit functional impairment
Maintain or improve quality of life

guideline
American college of rheumatology

Pharmacologic treatment

Pharmacologic treatment
Disease modifying OA drugs (DMOADs)
Structure modifying OA drugs (SMOAD)
Symptomatic slow acting drug for OA
(SYSADOA)

Symptomatic slow acting drug for OA

(SYSADOA)
Hyaluronic acid
Glucosamine sulfate, chondrotin sulfate
Diacerein
Avocado/ soybean unsaponifiable
Tetracycline : MMP inhibitor
Recombinant human superoxide dismultase
(rH-SOD)
Glycosaminoglycan polysulfuricacid,
Glycosaminoglycan-peptide complex,
pentosanpolysulfate

SYSADOA
Not enough evidence
Not recommended combination of drugs
in this class
Help to reduce pain as well as improve
joint mobility

Intra-articular therapy
Steroids
excellent pain relief but only used in
inflammed joints
limited to 3-4 injections per year
Hyaluronic acid
Not enough evidence
Alternative therapy to those who do not
response to oral medication

Reference
Dipiro JT, Talbert RL, Yee GC, Matake GR, Wells BG, Posey LM,
eds. (2011). Pharmacotherapy handbook. 8th ed. New York:
McGraw-Hill.
American college of Rheumatology. Osteoarthritis. Retrieved
from http://www.rheumatology.org/I-Am-A/PatientCaregiver/Diseases-Conditions/Osteoarthritis
Hochberg M, Altman R, April K. American college of
rheumatology 2012 recommendation s for the use of
nonpharmacologic and pharmacologic therapies in osteoarthritis
of the hand, hip, and knee. Arthritis care Res 2012;64(4): 465-74