Osteoarthritis/Gout

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Definition of Osteoarthritis (DJD)

Degenerative disorder with minimal articular inflammation/degeneration of cartilage and hypertrophy of bone at articular margins

Osteoarthritis (DJD)

Minimal inflammation, without systemic symptoms, pain relieved by rest, brief morning stiffness

Most commonly affected joints of Osteoarthritis

Distal interphalangel joints, carpormetacarpal joints of the thumb, hip, knee, cervical and lumbar spine, big toe joint

Cause of Secondary Osteoarthritis

Trauma, gout, rheumatoid arthritis, hyperparathyroidism, hemochromatosis, charcot joint

Demographics facts of Osteoarthritis

Most common for of joint disease, occur in weight bearing joints by 40 yrs old, more common in women than men, obesity a risk factor

Clinical Findings of Osteoarthritis

No systemic manifestations, insidious onset, pain worse w/activity or wt bearing, relieved by rest, crepitus over knee, joint effusion

Patient Evaluation for Osteoarthritis

Inflammation present? (redness, warmth, swelling, morning stiffness of atleast 30 min) How many joints involved? What joints are affected?

What joints does Osteoarthritis cheifly Affect

DIP, PIP and Rheumatoid arthritis affects wrist and MCP joints

Clues to diagnosis of Osteoarthritis/Rheumatoid Arthritis

Joint enlargemet bony-hard and cool/ Spongy and warm

Procedures and treatment for Osteoarthritis

Examine joint fluid ( synovial fluid noninflammatory), Aspiration of effusion for pain, corticosteroid injections for pain

Radiographic findings for Osteoarthritis

Narrowing of joint space, osteophyte formation, thickened, dense subchondral bone, bone cysts

Prevention of Osteoarthritis

Weight loss, exercise, correction of leg length discrepancy of >1cm (shoe modification), maintain Vit D levels

Treatment of Osteoarthritis

Moderate physical activity (walking, hydrotherapy, Tai Chai), wt loss

Pharmacological Treatment of Osteoarthritis

NSAIDs, Acetaminophen, topical Capsaicin cream, Diclofenac gel, intra-articular injection (triamcinolone), Chondroitin sulfate & glucosamine

Definition of Gout

Is a metabolic disease, abnormal amounts of urates in the body. Initially monoarticular.

Causes of Gout

Associated hyperuricemia d/t overproduction or underexcretion of uric acid( or both)

Diagnostic clues for Gout

Acute onset, usually nocturnal and monoarticular involving first MTP joint. Crystals or tophi on diagnostic. Therapeutic response to NSAIDs

Causes of Primary Gout

Heritable component linked to several genes related to urate handling by the kidney

Causes of Secondary Gout

R/T acquired causes of hyperuricemia (medications-diuretics, low-dose aspirin,cyclosporine, niacin) CKD, hypothyroidism, psoriasis, ETOH

Signs and symptoms of Gout

Sudden onset, frequently nocturnal, excessive ETOH, Joints swollen, tender, skin tense, warm and red. Fever common