Osteoarthritis Malaysian CPG 2013

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

Osteoarthritis Malaysian CPG 2013

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