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Difference between revisions of "Osteoarthritis"
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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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Note: | 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> | *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=== | ===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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====Gross only==== | ====Gross only==== | ||
<pre> | <pre> | ||
FEMORAL HEAD AND | 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). | - DEGENERATIVE JOINT DISEASE (GROSS ONLY). | ||
</pre> | </pre> | ||