A 55 year old female with BMI value of 40,presents with complain of pain in right knee joint,stiffnessand reduced range of movement.The X ray of right knee joint is shown in the image(along with a X ray of normal Knee joint for comparison on left side).What would be the most probable diagnosis?
A. Rheumatoid Arthritis
C. Psoriatic Arthritis
D. Reiter’s Disease
X ray of the knee joint shows narrowing of the joint space and subchondral sclerosis suggestive of Osteoarthritis.
- It can be thought of as a degenerative disorder arising from the biochemical breakdown of articular (hyaline) cartilage in the synovial joints. However, the current view holds that osteoarthritis involves not only the articular cartilage but the entire joint organ, including the subchondral bone and synovium.
- Osteoarthritis predominantly involves the weight-bearing joints, including the knees, hips, cervical and lumbosacral spine, and feet. Other commonly affected joints include the distal interphalangeal (DIP), proximal interphalangeal (PIP), and carpometacarpal (CMC) joints.
Risk factors for osteoarthritis :
- Obesity :Obesity increases the mechanical stress in a weight-bearing joint
- Genetics (significant family history)
- Reduced levels of sex hormones
- Muscle weakness
- Repetitive use (ie, jobs requiring heavy labor and bending)
- Crystal deposition
- Previous inflammatory arthritis (eg, burnt-out rheumatoid arthritis)
- Heritable metabolic causes (eg, alkaptonuria, hemochromatosis, Wilson disease)
- Hemoglobinopathies (eg, sickle cell disease and thalassemia)
- Neuropathic disorders leading to a Charcot joint (eg, syringomyelia, tabes dorsalis, and diabetes)
- Underlying morphologic risk factors (eg, congenital hip dislocation)
- Disorders of bone (eg, Paget disease and avascular necrosis)
- Previous surgical procedures (eg, meniscectomy)
- Deep, achy joint pain exacerbated by extensive use – The disease’s primary symptom
- Reduced range of motion and crepitus – Frequently present
- Stiffness during rest (gelling) – May develop, with morning joint stiffness usually lasting for less than 30 minutes
Osteoarthritis of the hand
- Distal interphalangeal joints are most often affected
- Proximal interphalangeal joints and the carpometacarpal joints at the base of the thumb are also typically involved
- Heberden nodes, which represent palpable osteophytes in the DIP joints, are more characteristic in women than in men.
- Plain radiography – The imaging method of choice: in the load-bearing areas, radiographs can depict joint-space loss, as well as subchondral bony sclerosis and cyst formation,osteophytes and joint deformity.
- The presence of noninflammatory joint fluid helps distinguish osteoarthritis from other causes of joint pain. Other synovial fluid findings that aid in the differentiation of osteoarthritis from other conditions are negative Gram stains and cultures, as well as the absence of crystals when fluid is viewed under a polarized microscope.
Nonpharmacologic interventions are the cornerstones of osteoarthritis therapy and include the following:
- Application of heat and cold
- Weight loss
- Physical therapy
- Occupational therapy
- Joint unloading, in certain joints (eg, knee and hip).
- Pain reliever and Anti-inflammatory like Acetaminophan,Ibuprofen,etc.
- Intra-articular pharmacologic therapy includes corticosteroid injection and viscosupplementation.
Surgical procedures for osteoarthritis include the following:
- Arthroplasty – Particularly with knee or hip osteoarthritis