{"id":8928,"date":"2021-12-08T21:48:06","date_gmt":"2021-12-08T18:48:18","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/rheumatology\/osteoarthritis-osteoarthrosis-spondylosis-degenerative-disorders-of-intervertebral-discs\/"},"modified":"2022-04-23T16:41:45","modified_gmt":"2022-04-23T14:41:45","slug":"osteoarthritis-osteoarthrosis-spondylosis-degenerative-disorders-of-intervertebral-discs","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/osteoarthritis-osteoarthrosis-spondylosis-degenerative-disorders-of-intervertebral-discs\/","title":{"rendered":"Osteoarthritis\/osteoarthrosis. Spondylosis, degenerative disorders of intervertebral discs"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" id=\"osteoarthritis-and-osteoarthrosis-oa\" class=\"wp-block-heading\" id=\"osteoarthritis-and-osteoarthrosis-oa\" class=\"title_collection title1\">Osteoarthritis and osteoarthrosis (OA)<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\" class=\"title_collection title2\">Introduction<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">The two terms are often used interchangeably, and this may seem quite confusing as osteoarthritis means inflammatory disease (-itis), while osteoarthrosis means degenerative disease (-osis).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In the past, the term osteoarthritis was considered to be a misnomer, as the disease was considered to be of purely degenerative purpose.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Today, however, the disease is known to be not simply a process of degeneration, but rather involves complex mechanisms including abnormal remodeling of joint tissues along with inflammation.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"description\" class=\"wp-block-heading\" id=\"description\" class=\"title_collection title2\">Description<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">OA is the most common form of arthritis. It is a slow and progressive disease characterized by damage to articular cartilage and subchondral bone, formation of osteophytes, and other joint changes.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Symptoms include pain associated with movement, short morning stiffness, and sometimes swelling of the joints.<\/li><li>Most commonly affects the weight bearing joints (knee, hip), but can also affect the joints of the hand and spine.<ul><li>The pattern is asymmetrical.<\/li><li>Can affect both PIP and DIP joints of the hand (compared with RA where DIP joints are spared), leading to <em>Heberden <\/em>and <em>Bouchard nodes<\/em>.<\/li><\/ul><\/li><li>Contributing factors include age (older), obesity, sex (females) and lifestyle.<\/li><li><strong>Etiology.<\/strong> OA can be primary (idiopathic) or secondary. <ul><li><strong>Primary OA<\/strong> can be sub-divided into primary generalized OA (if several joints are affected) or based on the specific joint it affects.<\/li><li><strong>Secondary OA<\/strong>. Results from conditions that lead to changes in the articular cartilage, including infectious and inflammatory diseases, endocrine and metabolic diseases, and trauma.<\/li><\/ul><\/li><li><strong>Diagnosis<\/strong><ul><li>Physical examination shows joint deformity, pain during active movement, and muscle atrophy.<\/li><li>Radiological imaging (displaying diffuse loss of joint space, osteophyte formation, subchondral cysts and sclerosis)<\/li><li><strong>ACR classification<\/strong> is useful for the diagnosis of hip or knee OA.<\/li><\/ul><\/li><li><strong>Treatment<\/strong>. <ul><li>Lifestyle modification (weight-loss, physiotherapy)<\/li><li>NSAIDs<\/li><li>Intra-articular steroids<\/li><li>Oral glucosamine<\/li><li>Joint replacement surgery<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"pathophisology\" class=\"wp-block-heading\" id=\"pathophisology\" class=\"title_collection title2\">Pathophisology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">The disease typically starts after a mechanical injury that a variety of changes in the microenvironment of the articular cartilage.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-2d9d1cd9-f536-4534-8562-5535557c5018\"><li>Faulty attempts repair attempts result in further damage, chondrocyte death, and loss of cartilage, and sclerosis of the subchondral bone.<\/li><li>The sclerosed bone becomes infarcted and develops cysts.<\/li><li>Osteophytes form in an attempt to stabilize the joint, resulting in loss of mobility.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h3 class=\"wp-block-heading\" id=\"spondylosis\" class=\"wp-block-heading\" id=\"spondylosis\" class=\"title_collection title1\">Spondylosis<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<p class=\"wp-block-paragraph\">Spondylosis is a degenerative disorder of the spine, most <span style=\"font-size: revert; color: initial;\">often at the levels of C5-C7 (<strong>cervical spondylosis<\/strong>), and L3-L5<\/span> (<strong>lumbar spondylosis<\/strong>).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Presents with back pain, decreased range of motion, radiculopathy (nerve compression), and\/or myelopathy (spinal cord compression).<ul><li>May present with pain, numbness, paresthesia, shock sensation; in the case of myelopathy, loss of coordination and motor skills.<\/li><li>Cauda equina syndrome may occur in severe spinal cord compression.<\/li><\/ul><\/li><li>Mostly appears in older adults (&gt;40)<\/li><li>Should not be confused with <strong>spondylitis<\/strong>, an inflammatory condition involving the spine and related joints.<\/li><li><strong>Diagnosis<\/strong>. Based on the clinical presentation and radiological imaging.<\/li><li><strong>Treatment<\/strong><ul><li>Physiotherapy; avoid movements that aggravate the pain<\/li><li>NSAIDs and peripheral antispasmodics (baclofen)<\/li><li>Decompression surgery<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"pathophysiology\" class=\"wp-block-heading\" id=\"pathophysiology\" class=\"title_collection title2\">Pathophysiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">The hallmark of the disease is IV disc degeneration characterized by its dessication (dehydration), decreased disc height, herniation, stiffening and loss of support and mechanical stability, leading to a variety of degenerative changes in the joints (uncovertebral, facet) and ligaments (posterior longitudinal, flavum) of the spine. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The mechanical instability leads to the reversal of the curvature (kyphosis), formation of bone spurs (in an attempt to stabilize the spine) projecting into and narrowing of the spinal canal and intervertebral foramina, and subsequently compression of the spine, its vessels, and nerve roots.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h3 class=\"wp-block-heading\" id=\"degenerative-disorders-of-the-iv-discs\" class=\"wp-block-heading\" id=\"degenerative-disorders-of-the-iv-discs\" class=\"title_collection title1\">Degenerative disorders of the IV discs<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">Degenerative discopathy is a chronic multifactorial disease which affects the a significant portion of the population. <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>It may be asymptomatic, or present with back pain, sciatica, radiculopathy and myelopathy, leading to significant morbidity.<\/li><li>A significant portion of the population is diagnosed with degenerative IV changes incidentally, without having any symptoms.<\/li><li>Most commonly affects the lower back (L4-L5, L5-S1)<\/li><li><strong>Diagnosis<\/strong><ul><li>Physical examination<ul><li>Pain and decreased ROM (bending test)<\/li><li>Straight-leg raise (Las\u00e8gue) test and reverse straight-leg raise test<\/li><\/ul><\/li><li>Radiological imaging (MRI is superior to CT)<\/li><\/ul><\/li><li><strong>Treatment<\/strong>. The herniated spinal disc may eventually heal on its own; it is advised to begin mobilization as soon as the pain becomes bearable, as it can speed up the healing.<ul><li>Physiotherapy<\/li><li>NSAIDs<\/li><li>Analgesics<\/li><li>Surgery<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" id=\"pathomechanism\" class=\"wp-block-heading\" id=\"pathomechanism\" class=\"title_collection title2\">Pathomechanism<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<p class=\"wp-block-paragraph\">Repetitive micro-trauma to the IV disc (incorrect weight lifting, twisting motions while bending over) along with predisposing genetic factors lead to spinal disc dessication and degeneration, characterized by:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Beginning of the degenerative process and weakening of the annulus fibrosus<\/li><li>Tearing and formation of a defect in the annulus with protrusion of the nucleus pulposus into the defect (<strong>disc prolapse<\/strong> or <strong>incomplete disc herniation<\/strong>)<\/li><li>Complete tearing of the defect, with herniation of the nucleous pulposus through the annulus (<strong>extrusion<\/strong>, <strong>disc herniation<\/strong>)<\/li><li>A part of the herniated nucleous pulposus breaks off and becomes loose in the spinal canal (<strong>sequesteration<\/strong>)<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The herniated disc may press on a nerve root leading to radiculopathy, or the spinal cord itself leading to myelopathy.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_9\">\n<h3 class=\"wp-block-heading\" id=\"references\" class=\"wp-block-heading\" id=\"references\" class=\"title_collection title1\">References<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_9\">\n\n\n<ol class=\"wp-block-list\"><li>Tanchev, Panayot. (2017). Osteoarthritis or Osteoarthrosis: Commentary on Misuse of Terms. <em>Reconstructive Review.<\/em> 7. 10.15438\/rr.7.1.178.<\/li><li>Loeser RF, Goldring SR, Scanzello CR, Goldring MB. Osteoarthritis: a disease of the joint as an organ.&nbsp;<em>Arthritis Rheum<\/em>. 2012;64(6):1697-1707. doi:10.1002\/art.34453<\/li><\/ol>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" id=\"osteoarthritis-and-osteoarthrosis-oa\" class=\"wp-block-heading\" id=\"osteoarthritis-and-osteoarthrosis-oa\">Osteoarthritis and osteoarthrosis (OA)<\/h3><h4 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\">Introduction<\/h4><h4 class=\"wp-block-heading\" id=\"description\" class=\"wp-block-heading\" id=\"description\">Description<\/h4><h4 class=\"wp-block-heading\" id=\"pathophisology\" class=\"wp-block-heading\" id=\"pathophisology\">Pathophisology<\/h4><h3 class=\"wp-block-heading\" id=\"spondylosis\" class=\"wp-block-heading\" id=\"spondylosis\">Spondylosis<\/h3><h4 class=\"wp-block-heading\" id=\"pathophysiology\" class=\"wp-block-heading\" id=\"pathophysiology\">Pathophysiology<\/h4><h3 class=\"wp-block-heading\" id=\"degenerative-disorders-of-the-iv-discs\" class=\"wp-block-heading\" id=\"degenerative-disorders-of-the-iv-discs\">Degenerative disorders of the IV discs<\/h3><h4 class=\"wp-block-heading\" id=\"pathomechanism\" class=\"wp-block-heading\" id=\"pathomechanism\">Pathomechanism<\/h4><h3 class=\"wp-block-heading\" id=\"references\" class=\"wp-block-heading\" id=\"references\">References<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Osteoarthritis and osteoarthrosis (OA) Introduction The two terms are often used interchangeably, and this may seem quite confusing as osteoarthritis means inflammatory disease (-itis), while osteoarthrosis means degenerative disease (-osis). In the past, the term osteoarthritis was considered to be a misnomer, as the disease was considered to be of purely degenerative purpose. Today, however, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8424,"menu_order":8,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8928","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Osteoarthritis\/osteoarthrosis. 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