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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 

ACR and EULAR have different 
  • ACRthe 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)
OA of the hand II: chemistry, pharmacokinetics and pharmacodynamics of naproxen, and clinical outcome studies 2014