Osteoarthritis

What is osteoarthritis?
Professor Ewa Roos
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark
[email protected]
A whole organ disease,
clinical diagnosis
No problem, I can fix
it with an artificial
joint
A costly disease:
11.5 mia annually in
Denmark
Pain and functional
limitations!
Person with
osteoarthritis
Close to 900.000
Danes self-report OA
Cartilage loss, Joint
space narrowing on
radiographs
Education, exercise
and a healthy weight is
effective treatment
Osteoarthritis
 Osteoarthritis (OA) also known as degenerative
arthritis or degenerative joint disease or
osteoarthrosis, is a group of mechanical abnormalities
involving degradation of joints, including articular cartilage and
subchondral bone.
Cartilage Matrix Degradation
Synovium
Protease
Protease
Fragments
Protease
Histology by E Hunziker
OA development
Structural changes
•radiographic
•arthroscopic
•MRI
•Biomarkers in
blood and
Joint fluid
Early phase
10-20 years
Courtesy: Leif Dahlberg
Late phase
A degenerative meniscal tear is a sign
of osteoarthritis
OA -a whole organ disease
NORMAL JOINT
Subchondral bone
Meniscus
Joint capsule
OSTEOARTHRITIS
Subchondral bone
thickening
Fibrotic
joint capsule
Degenerated
meniscus
Loss of cartilage
and joint space
Osteophytes
Cartilage
Bone cysts
Muscle weakness
Poor correlation between symptoms
and structural changes
Artrose diagnose checklist
Symptomer
Risikofaktorer
Belastningssmerte
☐ Alder (40+)
☐
Nedsat funktion
☐
☐
Morgenstivhed
☐ Overvægt
Kliniske fund
Køn (kvinde)
Tidligere ledskade
☐
☐
Krepitation
☐ Hårdt fysisk arbejde
☐
Nedsat bevæglighed
☐ Overbelastning i fritid
☐
Knogleudvækst
☐ Artrose i familien
☐
www.glaid.dk
OA is one disease with very different
risk factors
Dieppe and Lohmander.. Lancet 2005
Burden of disease ranking
”yearsRank
measured withYLD
lived with disability”
OA among top-20 already at age 40…
1
20
40
60
80
34 o 39 o 44 o 49 o 54 o 59 o 64 o 69 o 74 o 79 plus
o
t
t
t
t
t
t
t
t
t
t 0
30 35 40 45 50 55 60 65 70 75 8
Age Group
There ain’t no cure....
The OA Treatment Pyramid
First+second
+third line
treatment
First+second
line
treatment
First line
treatment
Few
Surgery
Pharmacological pain relief,
aids and passive treatments*
given by a therapist
Some
All
Education, exercise and weight control
© E Roos
Roos & Juhl. Osteoarthritis and Cartilage 2012
The OA Treatment Pyramid
First+second
+third line
treatment
First+second
line
treatment
First line
treatment
Few
Surgery
Pharmacological pain relief,
aids and passive treatments*
given by a therapist
Some
All
Education, exercise and weight control
© E Roos
Roos & Juhl. Osteoarthritis and Cartilage 2012
The OA Treatment Pyramid
First+second
+third line
treatment
First+second
line
treatment
First line
treatment
Few
Surgery
Pharmacological pain relief,
aids and passive treatments*
given by a therapist
Some
All
Education, exercise and weight control
© E Roos
Roos & Juhl. Osteoarthritis and Cartilage 2012
Land-based and aquatic exercise as
treatment for patients with
osteoarthritis in clinical practice





Ewa M. Roos
Carsten Juhl
Ben Waller (Finland)
Søren Thorgaard Skou
Facilitator: Marius Henriksen