1、OSTEOARTHRITIS OF THE KNEEBACKGROUNDOsteoarthritis : Most common causes of functional disability and severe pain The prevalence of arthritic symptoms among adults is more than 50% BACKGROUNDOsteoarthritis: Begining with damage and progressive degradation of articular hyaline cartilage structure and
2、function Cartilage thickness loss Remodeling and attrition of subarticular bone Growth of osteophytes Synovitis, ligamentous laxity, and periarticular muscle weakness Joint tilting and malalignment Normal and arthritic kneeEPIDEMIOLOGY risk factors Age Obesity Work-related bending and heavy physical
3、 workload Recreational and physical sporting activities Hyaluronic acid serum levels Knee injury Congenital conditions Systemic metabolic diseases Endocrine diseases Bone dysplasias Calcium crystal deposition diseasesCLASSIFICATION Primary (idiopathic) articular degeneration occurs in the absence of
4、 an obvious underlying abnormality Secondary result from some risk factors(injury ,repetitive motion such as found in certain occupations ,congenital conditions , systemic metabolic diseases,etc.)DIAGNOSISDiagnostic criteria for osteoarthritis of the knee (proposed by the American College of Rheumat
5、ology, ACR) First: presenting with pain Second:meeting at least five of the following criteria: Patient older than 50 years of age Less than 30 minutes of morning stiffness Crepitus (noisy, grating sound) on active motion Bony tenderness Bony enlargement No palpable warmth of synovium Erythrocyte se
6、dimentation rate (ESR) 40 mm/hr Rheumatoid factor 1:40 Noninflammatory synovial fluidDIAGNOSIS X-ray MRIDIAGNOSISMolecular biomarkers sC2C (serum cartilage type II collagen cleavage by collagenase ) sCPII (serum cartilage type II procollagen carboxy propeptide) sHA(serum hyaluronic acid) uNTX (urine
7、 N-terminal crosslinking telopeptide of type I collagen ) uCTX-II (urine cartilage type II collagen C-telopeptide ) uCTX-II(urine cartilage type II collagen C-telopeptide Relationships between biomarkers of joint metabolism and cartilage, bone, synovial metabolism may reflect early changes in cartilage structure w/o knee pain
