Osteoarthritis: Difference between revisions
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==Management== | ==Management== | ||
Nonpharmacological | |||
*weight loss | |||
*ice/warm packs | |||
*physical therapy | |||
*occupational therapy | |||
*exercise | |||
Pharmacological <ref> Jordan JM, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007 Jan. 34(1):172-80. </ref> | |||
*topical capsaicin | |||
*topical NSAIDs | |||
*oral NSAIDs | |||
*Tylenol | |||
*steroid injections | |||
*Tramadol | |||
Surgical | |||
*arthroscopy for removal of meniscal tears or loose foreign bodies | |||
**no additional benefit compared to PT and medical therapy in routine OA <ref> Kirkley A, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11. 359(11):1097-107 </ref> | |||
*osteotomy in young patients with misalignment of knee or hip joint | |||
*arthroplasty | |||
**if all other modalities are ineffective | |||
**prothetic knee/hip/shoulder usually has 10-15 year viability | |||
**infection, [[Pulmonary embolism]] are biggest risks | |||
*joint fusion | |||
**relieves pain but prevents motion | |||
**may be used in small foot/ankle bones or after failed arthroplasties | |||
==Disposition== | ==Disposition== | ||
Revision as of 02:30, 3 September 2015
Background
Risk Factors
- Age
- Female versus male sex
- Obesity
- Lack of osteoporosis
- Occupation
- Previous injury
- Muscle weakness
- Genetic elements
Clinical Features
- Commonly affected joints
- Cervical and lumbar spine
- First carpometacarpal joint
- Proximal interphalangeal joint
- Distal interphalangeal joint
- Hip
- Knee
- Subtalar joint
- First metatarsophalangeal joint
- Uncommonly affected joints
- Shoulder
- Wrist
- Elbow
- Metacarpophalangeal joint
Differential Diagnosis
Monoarticular arthritis
- Acute osteoarthritis
- Avascular necrosis
- Crystal-induced (Gout, Pseudogout)
- Gonococcal arthritis, arthritis-dermatitis syndrome
- Nongonococcal septic arthritis
- Lyme disease
- Malignancy (metastases, osteochondroma, osteoid osteoma)
- Reactive poststreptococcal arthritis
- Trauma-induced arthritis
- Fracture
- Ligamentous injury
- Overuse
- Avascular necrosis
- Decompression sickness
- Spontaneous osteonecrosis
- Hemorrhagic (e.g. hemophilia, systemic anticoagulation
- Seronegative spondyloarthropathies (ankylosing spondylitis, IBD, psoriatic arthritis, reactive arthritis
- RA, SLE
- Sarcoidosis, amyloidosis
- Periarticular pathology
- Transient (Toxic) Synovitis (Hip)
- Slipped Capital Femoral Epiphysis (SCFE)
- Legg Calve Perthes Disease
Polyarthritis
- Fibromyalgia
- Juvenile idiopathic arthritis
- Lyme disease
- Osteoarthritis
- Psoriatic arthritis
- Reactive poststreptococcal arthritis
- Rheumatoid arthritis
- Rheumatic fever
- Serum sickness
- Systemic lupus erythematosus
- Serum sickness–like reactions
- Viral arthritis
Diagnosis
- Greater than 50 years of age
- Morning stiffness for less than 30 minutes
- Crepitus on active motion of the knee
- Bony tenderness
- Bony enlargement
- No palpable warmth
Management
Nonpharmacological
- weight loss
- ice/warm packs
- physical therapy
- occupational therapy
- exercise
Pharmacological [1]
- topical capsaicin
- topical NSAIDs
- oral NSAIDs
- Tylenol
- steroid injections
- Tramadol
Surgical
- arthroscopy for removal of meniscal tears or loose foreign bodies
- no additional benefit compared to PT and medical therapy in routine OA [2]
- osteotomy in young patients with misalignment of knee or hip joint
- arthroplasty
- if all other modalities are ineffective
- prothetic knee/hip/shoulder usually has 10-15 year viability
- infection, Pulmonary embolism are biggest risks
- joint fusion
- relieves pain but prevents motion
- may be used in small foot/ankle bones or after failed arthroplasties
Disposition
See Also
External Links
References
- ↑ Jordan JM, et al. Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2007 Jan. 34(1):172-80.
- ↑ Kirkley A, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11. 359(11):1097-107