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8/17/2019 Osteoarthritis Malaysian CPG 2013
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Osteoarthritis
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Epidemiolog
• Osteoarthritis is a progressive joint disease due tofailure in repair of joint damage
• and O!"• #$% years old& more erosive and symptomati' in (ome
• ip O!"
• #)$ years old• *nee O!"
• lifetime ris+ of )),-. /y %$ years old& higher in history+nee injury and in'reased BM
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is+ fa'to
onmodi4a/le• !dvan'ing age
• 5emale
• 5amily history in6uen'eris+ for hand and +nee
O!• Presen'e of e/erden7s
nodes in hand O!in'rease the ris+ forfuture +nee O!
Modi4a/le
• BM 8#2$+g9m2:
• Previous +nee injury
• Malalignment• 8'ontri/utes to
progression:
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Classi4'atio
• Primary• Generalised O!& asso'iated (ith e/erden7s nodes andpolyarti'ular disease
• ;e'ondary• Meta/oli' eg a'romegaly& haema'hromatosis
• !natomi' eg ;
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;ymptom
• >oint pain ? in'reased /y joint use and impa't and relieved /y rest
• ;ti@ness ? o''urs after ina'tivity& lasts A30 minutes
• ;(elling ? fullness and s(elling (ith or (ithout (armth and loss of fun't
• Gait distur/an'e ? if involves (eight/earing joints& may have mus'lespasm
• Bony s(elling ? redu'ed deterity and 4ne movements if involves the ha
• oss of mus'le /ul+ ? due to ina'tivity se'ondary to pain
• im/ deformity ? enlargement of joins resulting in valgus9varus
• Cli'+ing or grinding sensation ? o''urs (ith joint motion
• nsta/ility ? reDuires (al+ing aids if involves the (eight/earing joints
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;ig
• !ltered gait if involved (eight /earing joints
• =enderness of soft tissues eg synovium& 'apsule&periarti'ular mus'les
• >oint s(elling due to synovitis9synovial e@usion9/oneenlargement
•
Crepitus• oss of fun'tion (ith redu'ed motion
• eformity ? su/luation of P>& varus9valgus +nees&shortening in hip O!
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iagnosis" and O
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iagnosis" ip O
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iagnosis" *nee O
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nvestigation
• iagnosis is 'lini'al
• Blood investigations and synovial 6uidanalysis seldom reDuired e'ept to e'ludeother diagnosis
•
Plain radiography of the joint is the standarimaging for assessing O!• ;hould /e done in the (eight /earing position
for +nee and hip O!,
• Classi'al features in'lude narro(ed joint spa'e
osteophytes& su/'hondral /one s'lerosis&
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;ynovial 6uid assessme
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magin
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magin
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Gradin
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Management" onPharma'ologi'
• Patient edu'ation
• nformation of the diagnosis& nature of disease& therapeuti' optioand importan'e of ongoing patient parti'ipation in the diseasemanagement
• ifestyle modi4'ation
• Feight redu'tion to redu'e pain and improve fun'tion
• Physi'al a'tivity ? lo(impa't aero/i' eer'ises 8(al+ing:&
strengthening eer'ises• Physiotherapy
• =o improve mus'le strength& /alan'e& 'oordination& mo/ility
• =rans'utaneous ele'trostimulation& thermotherapy
• O''upational therapy
• =o improve health& prevent disa/ility and help a'hieve optimum
fun'tional level and ! independen'e
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Management" Pharma'ologi'al 8Ora
• ;imple analgesi's ? para'etamol
• for mild to moderate pain• Fea+ opioid analgesi's ? tramadol
• May /e used alone or in 'om/ination (ith para'etamol
•
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Management" Pharma'ologi'al 8oora
• ntraarti'ular 'orti'osteroids egydro'ortisone• 5or shortterm pain relief in a'ute ea'er/ation
• ntraarti'ular vis'osupplementation /yhyaluroni' a'id• Controversial
• =opi'al ;!s eg di'lofena'& 'apsai'in• !djun't therapy in mild to moderate pain
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Management" ;urgi'
• !ssess need for surgery• Pain 'ausing sleep interruption and present
(hile resting
• imitations to ! 8(al+ing and self'are:
• Psy'hoso'ial (ell/eing
• E'onomi' impa't• e'ent deterioration
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• =ypes of surgery
• !rthros'opi' lavage (ith or (ithout de/ridement only in patients (ithloose /odies or 6aps of menis'us9'artilage in the joint
• igh ti/ial osteotomy if A$0 years old and has minimum 120o of +nee6eion
• =otal joint repla'ement reDuiring patient to avoid jogging and highimpa't sports for the rest of their life follo(ing surgery to ensureimplant longevity
• Partial joint repla'ement for patients (ith +nee O! a@e'ting a single'ompartment
• !rthrodesis to fuse the diseased joint in an optimal position if there ispain and signi4'ant ligamentous insta/ility in an unre'onstru'ta/le+nee follo(ing an infe'tion at the site of a +nee arthroplasty
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Management" e'ent !dvan'es on =ri
• ntraarti'ular stem 'ells to /oost reparativpro'ess and limit destru'tive pro'ess
• !utologous 'hondro'yte implantation totreat symptomati' +nee 'artilage defe'ts /re'ruitment of progenitor 'ells as potential
'artilage pre'ursors
• Platelet ri'h plasma to enhan'e tissueregeneration
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eferr
• eferral to rheumatology or orthopaedi' 'lini' if • !rthritis (ith un'lear diagnosis
• Patient does not eperien'e satisfa'tory improvement interms of pain& sta/ility or fun'tion despite adeDuatepharma'ologi'al and nonpharma'ologi'al treatment
• eferrals should provide information on
• iagnosis• ;everity and impa't on !
• Comor/idities
• elevant investigation results and 'urrent medi'ations