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The Patient With Osteoarthritis
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A 59-year-old man presents to the office with a 10-year history of progressive right knee pain. He reports 15 minutes of morning stiffness, which improves with activity and returns with prolonged inactivity. He states he has become progressively more immobile during the past 6 months and is no longer able to play tennis. He denies having any locking or clicking of his knee.
On physical examination, his BMI is 25 kg/m2. There is crepitus noted with flexing the knee, which is not warm, erythematous, or tender. A small effusion is noted with no evidence of joint instability.
Key Supporting Information
Osteoarthritis (OA) is a chronic, progressive, multifactorial and lifelong disease characterized by degenerative and inflammatory processes affecting joints and surrounding tissues, resulting in pain and functional disability. Despite the availability of treatments and practice guidelines for the management of OA, inadequacies in practices of clinicians and patients have been found, leading to suboptimal outcomes. OA meets the criteria of a chronic care disease model because it is a condition that requires ongoing adjustments by the affected person and interactions with the health care system. Therefore, preventive measures, education, pharmacotherapy and nonpharmacotherapy all contribute toward enhanced OA outcomes. Patient education and self-management are key because it engages patients in the management of their illness. An engaged patient tends to adhere to prescribed therapeutic regimens, thus reducing the burden of the disease. Even though there is limited high-quality evidence to support the use of chondroprotective therapies, these may be one component of a multidisciplinary OA care plan. A structured, multidisciplinary care plan that includes extensive patient education would be more beneficial in optimizing long-term outcomes for patients with OA.
OA affects 14% of adults aged 25 years and older and 34% (12.4 million) of individuals older than 65 years, compromising the quality of life of nearly 27 million Americans.
Though chronic diseases are not immediately life-threatening, these pose a significant threat to the health, economic status and quality of life for individuals, families and communities. The economic burden of OA is significant; patients with OA incur more than $16,000 per year in total health care costs, with pain medications accounting for approximately 15% of the total annual drug cost. The total cost in the United States for treating OA, its complications and associated disabilities is more than $60 billion annually.
Multiple risk factors and diseases are associated with OA. Although age is the greatest predictor of the development and progression of OA, mechanical forces produced by obesity, trauma and some physical activity (eg, occupation) play an important role in the determination of OA.
Images: Codario RA
Osteoarthritis of the hip and knee are two of the most important causes of pain and physical disability in community-dwelling adults. Typical findings of OA of the hands, hips and knees are joint space narrowing, sclerosis and osteophytosis. These changes result from inherited and mechanical stress factors that induce biochemical processes, resulting in leading to alterations in the subchondral bone and cartilage degradation. The strongest risk factors for OA are advancing age, obesity, joint injury, female gender (hip and knee) and genetic factors.
Symptomatic hand OA is a common disease among older patients and impairs hand function. This impairment is largely mediated by stiffness, which may last up to 30 minutes, and pain, which can be associated with inflammatory flares. Clinical findings include bony enlargement and joint space narrowing of the proximal and distal interphalangeal joints, with bone spurs that develop into Bouchard and Heberden nodes. When the carpometacarpal joint is involved, the joint may have a squared contour (Figure 1).
Typical symptoms of hip arthritis include pain in the groin, thigh or buttock, which is generally worse with weight-bearing (walking, standing) or twisting. Radiographic findings include asymmetric joint space narrowing, subchondral sclerosis, osteophyte formation and subluxation (Figure 2).
Osteoarthritis of the knee can be associated with asymmetric joint space narrowing, causing a varus (medial joint space narrowing and bow legs) or valgus (lateral joint space narrowing and knocked knees). This can be best imaged with both supine and erect films. Computed tomography (CT) of the knee evaluates pathologic changes in bone, as well as osteomyelitis, bone erosions and occult fractures with high sensitivity. Magnetic resonance imaging (MRI) can be useful to evaluate soft tissue structures, eg, ligaments, tendons and meniscal tears. Small to moderate effusions can occur with OA of the knee and the joint fluid is noninflammatory. Diagnostic joint aspiration is usually not necessary for diagnostic purposes in the absence of joint inflammation and clinical findings consistent with OA.
Learning Objectives:
Upon successful completion of this educational activity, participants should be better able to assess ankylosing spondylitis.
Overview
Author(s)/Faculty: Ronald A. Codario, MD, FACP, FNLA, RPVI, CCMEP
Source: Healio Rheumatology Education Lab
Type: Monograph
Articles/Items: 7
Release Date: 10/15/2015
Expiration Date: 10/15/2016
Credit Type: CME
Number of Credits: 1
Cost: Free
Provider: Vindico Medical Education
CME Information
Provider Statement: This continuing medical education activity is provided by Vindico Medical Information.
Support Statement: No commercial support for this activity.
Target Audience: This activity is designed for this activity is rheumatologists and other health care professionals involved in the treatment of patients with rheumatological disorders.