osteoarthritis_concept_map
osteoarthritis concept map zoom out pharmacotherapy

Definition

The map starts with osteoarthritis (OA) definition which states that OA is a degenerative non-inflammatory joint disease that is characterized by:

  • Progressive damage to the articular cartilage
  • Thickening of subchondral bone & joint capsule
  • Formation of osteophytes
  • Mild synovitis

Classification

Osteoarthritis is classified into:

  1. Idiopathic (primary) OA; there is no known underlying or predisposing cause.
  2. Secondary OA; which is associated with predisposing factors as: trauma, repetitive stress (occupation, sports), congenital abnormality, metabolic disorder, endocrine disorder (DM, obesity), or other bone/joint disease (Rheumatoid Arthritis, gout).

Epidemiology

· Prevalence

  • most common joint disease
  • most common form of arthritis
  • most common reason for total hip & total-knee replacement
  • causes high morbidity and financial loss due to the important joints involved
  • knee OA is a leading cause of chronic disability in elderly
  • >90 % of persons > 40 yo have some radiographic changes of OA in weight-bearing
  •  joints, but only 30% are symptomatic

· Predominant age: 

>50 yr

· Sex

  • Hip OA: men > women
  • OA of interphalangeal joints, thumb base, and knee is more common in women

· Race: 

There are differences in prevalence and pattern of involved joints.

Risk Factors

The most powerful risk factor for osteoarthritis is age. The most common risk factors are:

  • obesity (in women, there is a linear relationship between weight and risk),
  • previous occupation,
  • certain sports,
  • previous joint trauma
  • genetic predisposition
  • female gender
  • congenital/developmental defects
  • prior inflammatory joint disease
  • metabolic/endocrine disorders

Osteoarthritis develops when systemic factors combine with biomechanical susceptibilities. Systemic factors include age, gender, genetic predisposition, and nutritional status.

Pathophysiology

In order to understand osteoarthritis pathophysiology, you have to understand first its normal physiology. Thus, the map provides a brief explanation of the normal physiology, including articular cartilage functions, structure, and composition. After that, the map presents osteoarthritis pathophysiology through the following diagram:

Clinical Presentation & Diagnosis

General signs and symptoms

– Presentations from asymptomatic to severe joint pain, stiffness with functional limitations

– Asymmetric joint involvement

– No systemic manifestations

Joint pain

  • may affect ≥ 1 joint
  • deep ache
  • worsened by use and relieved by rest
  • persists during rest (in advanced cases)
  • nocturnal pain interfering with sleep (in advanced hip OA)

Joint stiffness

  • after periods of inactivity (e.g., sleep or automobile ride)
  • lasts < 20 minutes
  • impairs daily activities
  • may be related to weather

• Mild synovitis (in advanced cases)
• Joint instability in weight-bearing joints
• Joint/bony crepitus (the sensation of bone rubbing against bone, evoked by joint movement)

Common sites in primary and secondary osteoarthritis are shown in images included in the map.

Joint examination 

It may reveal:

  • local tenderness, bony proliferation, soft tissue swelling,
  • muscle atrophy, limited motion, and effusion.

Laboratory Tests

  • No specific laboratory test.
  • Aspirated synovial fluid (if obtained): leukocytosis and high viscosity.

Other Diagnostic Tests

  • Radiologic evidence may be misleading
  • Radiographic changes may include:
          are often absent in early osteoarthritis
    joint-space narrowing, subchondral bone sclerosis, and osteophytes (with disease progression)
    gross deformity and effusions (late osteoarthritis)

Osteoarthritis Treatment

The map details pharmacological treatment and offers brief information about non-pharmacological treatment and surgical interventions. A treatment algorithm for osteoarthritis is also included.

Medications used for the treatment of osteoarthritis are represented in the form of a comparison table. The table includes:

•      Analgesics: Acetaminophen and Non-steroidal Anti-inflammatory Drugs (NSAIDs).

•      Glucosamine and Chondroitin.

•      Intra-articular therapy: Corticosteroids and Hyaluronic acid (Hyaluronan)

•      Opioid analgesics (Tramadol)

•      Topical analgesics: Topical NSAIDs Counterirritant.

The comparison includes medications’ mechanisms of actions, indications, dosages, adverse drug reactions, drug interactions, precautions, and contraindications. 

osteoarthritis_medications_comparison
Osteoarthritis medications comparison

Order the map

You can order the Osteoarthritis concept map in any of the following forms according to your preference. Our maps are comprehensive in a way that can benefit both students and clinicians.

This map is available in two forms;
1. Printable version.
2. Whole map version.

Check them out below to know the difference, so that you can choose what is suitable for you. And please feel free to leave your feedback, comments, or questions in the comments section below.

(See also Rheumatoid Arthritis Concept Map)

Osteoarthritis Concept Map by Maha Atef, B Pharm.
Version: 2.0Last updated in: 1 July 2014

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