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>{{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 (eburnation).
#Loss of cartilage, especially asymmetrical.
*Osteophyte formation.
#*Marble-like appearance - polished appearance known as ''eburnation''.
*Subchondral cysts.
#[[Osteophyte]] formation.
*Subchondral sclerosis.
#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.
 
Memory device ''LOSS'':
*''L''oss of cartilage, ''O''steophyte formation, ''S''ubchondral cysts, ''S''ubchondral sclerosis.
 
Notes:
*Osteophytes are classically medial and lateral in the hip.<ref name=pmid12597129>{{Cite journal  | last1 = Claassen | first1 = H. | last2 = Tschirner | first2 = T. | title = Topographical and histological examination of osteophytes taken from arthrotic femoral heads. | journal = Ann Anat | volume = 185 | issue = 1 | pages = 67-71 | month = Jan | year = 2003 | doi =  | PMID = 12597129 }}</ref>
**They tend to form in areas with high loading.
*Subchondral cysts are also seen in [[rheumatoid arthritis]].<ref name=pmid404905/>
 
Clinical findings (external):
*Heberden's node - swelling of distal interphalangeal joints.
 
==Microscopic==
Features:<ref name=Ref_WMSP658>{{Ref WMSP|658}}</ref>
*Vertical clefts of the cartilage - characteristic.
*Thickening of [[bone|bony]] trabeculae (reactive phenomenon) due to fibrosis.
*Subchondral cysts (associated with cartilage loss).
*+/-Mild inflammation (lymphocytes).
*+/-Villous hyperplasia - synovium has finger-like projections into the joint space.
**Normal synovium has a flat surface.
*Osteophytes - ossified projections at the edge of the articular cartilage (bony spurs).
 
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://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://images.rheumatology.org/viewphoto.php?imageId=2862378 OA (rheumatology.org)].
*[http://www.med.nyu.edu/medicine/labs/abramsonlab/images/Fig-2-cartilage_histology-orig.jpg?CSRT=6720621554912944884 OA versus normal (med.nyu.edu)].<ref>URL: [http://www.med.nyu.edu/medicine/labs/abramsonlab/basic-arth-research.html http://www.med.nyu.edu/medicine/labs/abramsonlab/basic-arth-research.html]. Accessed on: 10 November 2012.</ref>
*[http://www.medic.usm.my/~pathology/bonepath/bonepath/Ostart2.jpg OA with clefting (usm.my)].<ref>URL: [http://www.medic.usm.my/~pathology/bonepath/bonepath/Osteoathritis.html http://www.medic.usm.my/~pathology/bonepath/bonepath/Osteoathritis.html]. Accessed on: 22 November 2012.</ref>
*[http://images.rheumatology.org/viewphoto.php?albumId=75691&imageId=2862380 OA with clefting (rheumatology.org)].
 
==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===
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 soft tissue shows a minimal, focal chronic inflammatory cells.


Memory device: ''LOSS'' = loss of cartilage, osteophyte formation, subchondral cysts, subchondral sclerosis.
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==
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*[[Bone]].
*[[Bone]].
*[[Chondro-osseous tumours]].
*[[Chondro-osseous tumours]].
*[[Arthritis]].
**[[Rheumatoid arthritis]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Soft tissue lesions]]
[[Category:Soft tissue lesions]]
[[Category:Diagnosis]]
Michael
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