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Osteoarthritis (OA): Clinical findings

OA Clinical findings

Osteoarthritis: Pathogenesis and clinical findings Ehlers-Danlos Syndromes (connective tissue disorders, e.g., Familial Hypermobility Syndromes) Damage of normal cartilage under abnormal loading Authors: Sean Spence Modhawi Alqanaie Reviewers: Yan Yu Jennifer Au Mao Ding Gary Morris* * MD at time of publication Single large traumatic event or repeated microtrauma Damage to normal articular cartilage under normal loading (force put on a joint) Genetic anomalies in cartilage production and inborn errors of cartilage metabolism Damage of abnormal cartilage under normal joint loading Destruction/attrition of articular cartilage Osteoarthritis A degenerative joint disease that can affect both load bearing joints (knee, hip) as well as in smaller joints (proximal inter-phalangeal, carpometacarpal joints in hand) Repeated physical joint trauma Aberrant bone deposition secondary to wear on subchondral bone Formation of osteophytes (bony projections) and subchondral sclerosis (bone thickening) Lack of cartilage Direct contact between bony processes with movement of the joint Inflammation alters the chemical milieu of joint tissue Synovial fluid forced into bone Damage to subchondral (under cartilage) blood vessels Subchondral fractures cytokines regulate hyaluronic acid synthase Synovium makes lower molecular weight hyaluronic acids (a potent proinflammatory molecule) ↓ synovial fluid viscosity ↑ risk of infection Increased secretion of proteolytic enzymes ↑ joint fluid production Joint effusion Disruption of normal joint architecture Palpable bony hypertrophy (ex. Bouchard’s nodes (bony bumps on the middle joints of the finger)) Impaction of osteophyte with normal joint structures during movement Physical disability Crepitus (grating sound in a joint) Joint movement with reduced lubrication stimulates joint nociceptors Stimulation of joint nociceptors (sensory receptors that detect damaging stimuli) in subchondral bone Pain with use of joint Pain with motion ↓ Range of motion Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published November 1, 2012, updated May 18, 2023 on www.thecalgaryguide.com