Pathophysiology:
 Osteoarthritis Lancet 2015
- mechanical stress leads to cartilage damage, and sub-chondral bone changes
- Mensical demange, Ligaments tears, Synovitis leads to production of Cytokines, Chemokines, Growth factors, MMPs and these lead to damage of articular cartilage.
Primary or Idiopathic OA- Localized
- Generalized (3 or more joint sites are involved)
Secondary OA- Usually occurs at a site where primary OA does not occur
OA of Hand (DIP, 1st CMC, PIP)
Clinical Features: - Heberden's Node: Enlargement of DIP
- Bouchard's Node: Enlargement of PIP
- "Squaring" of CMC joint due to OA of 1st CMC joint
Diagnosis: ACR and EULAR have different criterias: - ACR: the criteria to be met for hand OA are:
- (1) pain in the hand, aching or stiffness;
- (2) hard tissue enlargement of 2/10 selected joints in the hand (the selected joints include the second and third DIP joints, second and third PIP joints, and the first CMC joint of both hands);
- (3) fewer than three swollen MCP joints;
- (4) hard tissue enlargement of two or more DIP joints, or deformity in two or more of the 10 selected joints
Treatment: ACR 2012- Non-pharmacological
- Evaluate for ability to do ADL; Provide assistive device PRN for ADL
- Joint Protection Techniques
- Thermal Modalities
- Splints for patient with TMC joint OA
- Reference:
- The Arthritis, Diet, and Activity Promotion Trial (ADAPT) study
- Pharmacological
- Topical Capsaicin
- Topical NSAIDs, including topical salicylate
- Oral NSAIDS
- Tramadol
- >75 avoid oral drugs, and preferentially use topical drugs
- Acetaminophen is not of much help
- Surgical Indication:
- Radiographical Changes do not co-relate with the severity, and patients symptoms often dictates the need of surgery
Mechanism of Action of NSAIDs (including Naproxen) |
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