Difference between revisions of "Osteoarthritis"

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Osteoarthritis (view source)

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Degenerative joint disease - severe - alt -- low mag.jpg
| Width      =
| Caption    = Severe degenerative joint disease. [[H&E stain]].
| Synonyms  =
| Micro      = vertical clefts of the cartilage, +/-thickening of [[bone|bony]] trabeculae, subchondral cysts (where there is cartilage loss), +/-mild inflammation (lymphocytes), +/-villous hyperplasia (synovium has finger-like projections into the joint space), osteophytes (ossified projections at the edge of the articular cartilage)
| Subtypes  =
| LMDDx      = [[rheumatoid arthritis]], infectious arthritis, arthritis secondary to other disease (IBD, rheumatologic condition), trauma/deformity related, [[AVN]]-related
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      = thinning/loss of cartilage, osteophyte formation, subchondral cysts, subchondral sclerosis
| Grossing  = [[femoral head grossing]], [[knee replacement specimen grossing]]
| Site      = [[joints]], e.g. [[femoral head]], knee, shoulder
| Assdx      = trauma to joint, [[obesity]] (for knees), congenital disease ([[SCFE]], [[Legg–Calvé–Perthes disease]]), complication of [[avascular necrosis of the femoral head]]
| Syndromes  =
| Clinicalhx = often old, +/-history of trauma
| Signs      =
| Symptoms  = joint pain worse with activity, "morning stiffness"
| Prevalence = very common
| Bloodwork  =
| Rads      = joint space narrowing, osteophyte formation, subchondral cysts, subchondral sclerosis
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other types of [[arthritis]]
| Tx        = pain medications, joint replacement
}}
'''Osteoarthritis''', abbreviated '''OA''', is a degenerative disease of the joint.
'''Osteoarthritis''', abbreviated '''OA''', is a degenerative disease of the joint.


==General==
==General==
Clinical:
*Morning stiffness (<30 minutes).<ref name=pmid24881169>{{Cite journal  | last1 = Negoescu | first1 = A. | last2 = Ostör | first2 = AJ. | title = Self-management pivotal in osteoarthritis. | journal = Practitioner | volume = 258 | issue = 1770 | pages = 25-8, 3 | month = Apr | year = 2014 | doi =  | PMID = 24881169 }}</ref>
*Worse with exercise.<ref>URL: [http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm http://www.nlm.nih.gov/medlineplus/ency/article/000423.htm]. Accessed on: October 25, 2014.</ref>
Management:
*Acetaminophen (paracetamol).
*Other analgesics.
*Joint replacement.
===Risks===
===Risks===
It is associated with:<ref name=pmid20302555>{{Cite journal  | last1 = Martel-Pelletier | first1 = J. | last2 = Pelletier | first2 = JP. | title = Is osteoarthritis a disease involving only cartilage or other articular tissues? | journal = Eklem Hastalik Cerrahisi | volume = 21 | issue = 1 | pages = 2-14 | month = Apr | year = 2010 | doi =  | PMID = 20302555 | url=http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www.tevak.org-images-Eklemlinkout.png }}
It is associated with:<ref name=pmid20302555>{{Cite journal  | last1 = Martel-Pelletier | first1 = J. | last2 = Pelletier | first2 = JP. | title = Is osteoarthritis a disease involving only cartilage or other articular tissues? | journal = Eklem Hastalik Cerrahisi | volume = 21 | issue = 1 | pages = 2-14 | month = Apr | year = 2010 | doi =  | PMID = 20302555 | url=http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www.tevak.org-images-Eklemlinkout.png }}
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*Advanced age.
*Advanced age.
*Trauma.
*Trauma.
*Unusual loading (bony misalignment, obesity).  
*Unusual loading (bony misalignment, [[obesity]]).


==Gross pathology/radiology==
==Gross pathology/radiology==
Features:<ref name=pmid11476273>{{Cite journal  | last1 = Swagerty | first1 = DL. | last2 = Hellinger | first2 = D. | title = Radiographic assessment of osteoarthritis. | journal = Am Fam Physician | volume = 64 | issue = 2 | pages = 279-86 | month = Jul | year = 2001 | doi =  | PMID = 11476273 | url= http://www.aafp.org/afp/2001/0715/p279.html }}</ref>
Features - joints (internal):<ref name=pmid11476273>{{Cite journal  | last1 = Swagerty | first1 = DL. | last2 = Hellinger | first2 = D. | title = Radiographic assessment of osteoarthritis. | journal = Am Fam Physician | volume = 64 | issue = 2 | pages = 279-86 | month = Jul | year = 2001 | doi =  | PMID = 11476273 | url= http://www.aafp.org/afp/2001/0715/p279.html }}</ref>
#Loss of cartilage, especially asymmetrical.  
#Loss of cartilage, especially asymmetrical.  
#*Marble-like appearance - polished appearance known as ''eburnation''.
#*Marble-like appearance - polished appearance known as ''eburnation''.
#Osteophyte formation.
#[[Osteophyte]] formation.
#Subchondral cysts - located where there is loss of cartilage.<ref name=pmid404905>{{Cite journal  | last1 = Resnick | first1 = D. | last2 = Niwayama | first2 = G. | last3 = Coutts | first3 = RD. | title = Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint. | journal = AJR Am J Roentgenol | volume = 128 | issue = 5 | pages = 799-806 | month = May | year = 1977 | doi =  | PMID = 404905 }}</ref>
#Subchondral cysts - located where there is loss of cartilage.<ref name=pmid404905>{{Cite journal  | last1 = Resnick | first1 = D. | last2 = Niwayama | first2 = G. | last3 = Coutts | first3 = RD. | title = Subchondral cysts (geodes) in arthritic disorders: pathologic and radiographic appearance of the hip joint. | journal = AJR Am J Roentgenol | volume = 128 | issue = 5 | pages = 799-806 | month = May | year = 1977 | doi =  | PMID = 404905 }}</ref>
#Subchondral sclerosis.
#Subchondral sclerosis.
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**They tend to form in areas with high loading.
**They tend to form in areas with high loading.
*Subchondral cysts are also seen in [[rheumatoid arthritis]].<ref name=pmid404905/>
*Subchondral cysts are also seen in [[rheumatoid arthritis]].<ref name=pmid404905/>
Clinical findings (external):
*Heberden's node - swelling of distal interphalangeal joints.


==Microscopic==
==Microscopic==
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*Osteophytes - ossified projections at the edge of the articular cartilage (bony spurs).
*Osteophytes - ossified projections at the edge of the articular cartilage (bony spurs).


Images:
Note:
*Cartilaginous calcification is seen with OA; however, it is thought to be due to aging.<ref name=pmid17276093>{{Cite journal  | last1 = Mitsuyama | first1 = H. | last2 = Healey | first2 = RM. | last3 = Terkeltaub | first3 = RA. | last4 = Coutts | first4 = RD. | last5 = Amiel | first5 = D. | title = Calcification of human articular knee cartilage is primarily an effect of aging rather than osteoarthritis. | journal = Osteoarthritis Cartilage | volume = 15 | issue = 5 | pages = 559-65 | month = May | year = 2007 | doi = 10.1016/j.joca.2006.10.017 | PMID = 17276093 }}</ref>
 
DDx:
*Osteoarthritis secondary to another cause.
**[[Avascular necrosis of the femoral head]].
**Trauma.
**[[Slipped capital femoral epiphysis]] (SCFE).<ref>{{Cite journal  | last1 = Abraham | first1 = E. | last2 = Gonzalez | first2 = MH. | last3 = Pratap | first3 = S. | last4 = Amirouche | first4 = F. | last5 = Atluri | first5 = P. | last6 = Simon | first6 = P. | title = Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. | journal = J Pediatr Orthop | volume = 27 | issue = 7 | pages = 788-95 | month =  | year =  | doi = 10.1097/BPO.0b013e3181558c94 | PMID = 17878786 }}</ref>
 
===Grading===
A grading system exists from ''Pritzker'' and colleagues:<ref name=pmid16242352>{{Cite journal  | last1 = Pritzker | first1 = KP. | last2 = Gay | first2 = S. | last3 = Jimenez | first3 = SA. | last4 = Ostergaard | first4 = K. | last5 = Pelletier | first5 = JP. | last6 = Revell | first6 = PA. | last7 = Salter | first7 = D. | last8 = van den Berg | first8 = WB. | title = Osteoarthritis cartilage histopathology: grading and staging. | journal = Osteoarthritis Cartilage | volume = 14 | issue = 1 | pages = 13-29 | month = Jan | year = 2006 | doi = 10.1016/j.joca.2005.07.014 | PMID = 16242352 }}</ref>
{| class="wikitable sortable"
! Grade
! Key feature
! Additional findings
|-
| Grade 0 (normal)
| surface intact
| normal thickness
|-
| Grade 1
| surface intact but uneven
| +/-surface fibrillation, +/-superficial proliferation/cellular enlargement
|-
| Grade 2
| discontinuous surface (diffuse superficial fibrillation ''or'' surface abrasions)
| +/-chondron columns disoriented
|-
| Grade 3
| vertical fissures (simple or branched)
| +/-new collagen formation (seen with polarized light)
|-
| Grade 4
| erosion (cartilage loss)
| +/- cartilageous cyst formation
|-
| Grade 5
| complete cartilage loss
| no deformation
|-
| Grade 6
| deformed bone (osteophytes peripheral or central)
| +/-deformation of articular surface +/-microfractures
|}
 
===Images===
<gallery>
Image: Degenerative joint disease - severe -- very low mag.jpg | Severe DJD - very low mag.
Image: Degenerative joint disease - severe - alt -- very low mag.jpg | Severe DJD - very low mag.
Image: Degenerative joint disease - severe -- low mag.jpg | Severe DJD - low mag.
Image: Degenerative joint disease - severe - alt -- low mag.jpg | Severe DJD - low mag.
Image: Degenerative joint disease - severe -- intermed mag.jpg | Severe DJD - intermed. mag.
</gallery>
<gallery>
Image: Degenerative joint disease -- very low mag.jpg | Moderate DJD - very low mag.
Image: Degenerative joint disease -- low mag.jpg | Moderate DJD - low mag.
Image: Degenerative joint disease - alt -- low mag.jpg | Moderate DJD - low mag.
Image: Degenerative joint disease -- intermed mag.jpg | Moderate DJD - intermed. mag.
Image: Degenerative joint disease - alt -- intermed mag.jpg | Moderate DJD - intermed. mag.
</gallery>
www:
*[http://ars.els-cdn.com/content/image/1-s2.0-S8756328212000683-gr1.jpg Osteoarthritis showing villous hyperplasia - panel B (els-cdn.com)].
*[http://ars.els-cdn.com/content/image/1-s2.0-S8756328212000683-gr1.jpg Osteoarthritis showing villous hyperplasia - panel B (els-cdn.com)].
*[http://www.medpath.info/MainContent/Skeletal/3097.GIF Osteophyte (medpath.info)].<ref>URL: [http://www.medpath.info/MainContent/Skeletal/Joint_02.html http://www.medpath.info/MainContent/Skeletal/Joint_02.html]. Accessed on: 10 November 2012.</ref>
*[http://www.medpath.info/MainContent/Skeletal/3097.GIF Osteophyte (medpath.info)].<ref>URL: [http://www.medpath.info/MainContent/Skeletal/Joint_02.html http://www.medpath.info/MainContent/Skeletal/Joint_02.html]. Accessed on: 10 November 2012.</ref>
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==Sign out==
==Sign out==
===Hip===
<pre>
FEMORAL HEAD, RIGHT, HIP ARTHROPLASTY:
- DEGENERATIVE JOINT DISEASE.
</pre>
====Gross only====
<pre>
FEMORAL HEAD AND JOINT CAPSULE, RIGHT, EXCISION:
- DEGENERATIVE JOINT DISEASE (GROSS ONLY).
</pre>
<pre>
FEMORAL HEAD AND JOINT CAPSULE, LEFT, EXCISION:
- DEGENERATIVE JOINT DISEASE (GROSS ONLY).
</pre>


===Knee===
<pre>
SYNOVIUM, LEFT KNEE, BIOPSY:
- SYNOVIUM WITH MILD CHRONIC INFLAMMATION AND VILLOUS HYPERPLASIA -- COMPATIBLE
WITH OSTEOARTHRITIS.
</pre>


===Micro===
===Micro===
The sections show thinned cartilage composed of chrondrocytes clusters separated by vertical fibrous septa. The deep aspect of the cartilage is basophilic. An osteophyte is present.   
The sections show thinned cartilage composed of chrondrocytes clusters separated by vertical fibrous septa. The deep aspect of the cartilage is basophilic. An osteophyte is present.   


There is no complete cartilage loss. No subchondral cysts are identified. Subchondral sclerosis is not apparent.  
The soft tissue shows a minimal, focal chronic inflammatory cells.


The soft tissue shows a mild, focal lymphoplasmacytic infiltrate. There are no well-formed collections of inflammatory cells.
Note:
*''Noninflammatory degenerative joint disease'' is the term used by the ICD.<ref>URL: [http://www.icd9data.com/2012/Volume1/710-739/710-719/715/715.9.htm http://www.icd9data.com/2012/Volume1/710-739/710-719/715/715.9.htm]. Accessed on: 15 March 2013.</ref>


==See also==
==See also==
Michael
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