ARTHRITIS & OSTEOPOROSIS TASMANIA 19A Main Road, Moonah

2. ARTHRITIS & OSTEOPOROSIS TASMANIA 19A Main Road, Moonah FREE-CALL INFORMATION LINE …. 1800 011 041

3. Thank you for your interest • This session we will look at: • Musculoskeletal System • Introduction to Arthritis • Considerations for care provision • For your residents & for your joint and bone health.

4. Musculoskeletal System 1

5. The musculoskeletalsystem comprises • skeleton, including the bones and joints • cartilage • tendons • ligaments • bursa • meniscus • skeletal muscles. 2&3

6. Bones • At birth, there are over 270 bones in an infant human's body. • In adults there are 206 bones. • Bone 'growth' does not stop just because we have reached our adult size. • Our bones continue to ‘grow’, we just don't notice this as the growth is happening within the structure of the bone. 5

7. Four Main Shapes of Bones • Long – (has shaft and two ends) – femur, finger • Short – (support not movement) – patella • iii. Irregular bones – (protection/multiple attachment points for skeletal muscles) – vertebrae, sacrum • Flat - (protection/muscle attachment) – scapula, skull 4

8. Function of Bones • provide attachment points - tendons and ligaments • facilitate movement • store minerals such as calcium • produce blood cells. • Each bone in the body is a complex living organ - made up of many cells, fibres and minerals.

9. Cartilage • Cartilage is a unique tissue, a strong, flexible form of connective tissue that covers the ends of the bones within a joint. • Cartilagereduces friction between bone ends when they move. • It provides the 'gliding surface‘ and can withstand loads. • Cartilage does not contain blood vessels and has a limited capability to repair.

10. Cartilage

11. Ligaments • Ligaments are dense bundles of tough fibrous connective tissue. • They connect bones to other bones – holding them together as a joint. • Ligaments fasten around or across bone ends and permit varying degrees of movement of the joint. • They offer stability to the joint and to the movements the joint makes.

12. Tendons • Tendons are also bands of fibrous connective tissue. They connect muscles to bone. • Tendons are very strong – this is to withstand the stress and force that is generated by contraction of the muscle. • The tendons and the muscles then work together to move the bones. • Like all soft tissue structures, they can tear and/or become inflamed. 6

13. Skeletal Muscles • Skeletal muscles are the other key part of this system. • We have approximately 650 skeletal muscles. • Each muscle in the body is a discrete organ. • Skeletal muscles usually work in pairs or functional groups - in order to perform a particular movement.

14. Other musculoskeletal bits…….. • Meniscus – is a crescent shaped structure that disperses the load/ weight between bones in a joint during tension and torsion and reduces friction. • Bursa – small fluid-filled sacs lined by synovial membrane with an inner capillary layer of viscous fluid (similar in consistency to that of a raw egg white). • They provide a cushion between bones and tendons and/or muscles around a joint.

15. Joints • A joint is defined as 'any place in the skeleton where two or more bones meet.'  • The shape of the bones and how they are joined determines how the joint moves and the amount of movement it can make. • Some joints are very simple and others are complex. • This is based on their location and the purpose that they serve in the body.

16. Joints • There are three different types of joints – based on their structure and the movement they allow. • Fibrous – very limited movement, very stable (sutures of the skull) • Cartilaginous – minimal movement (sternum & rib joints) • Synovial – most movement. • Synovial joints are the joints most affected by types of arthritis. synovial joint 7

17. The Musculoskeletal System • All together now!! • skeletal muscles • bones • 360 joints • ligaments • tendons • bursae • 4 menisci • = • 6280structures within the musculoskeletal system.

18. What is Arthritis? 8

19. Arthritis • Not a single disease. • Over 150 different musculoskeletal conditions that come under the ‘umbrella’ of arthritis. • Not just a disease of elderly people. • They affect newborn babies through to elderly people. • Not a natural consequence of growing old.

22. Arthritis • Affect bones, joints, cartilage, muscles, tendons, ligaments and other connective tissues of the body. • Also in some cases, organs of the body too. • They are the major cause of disability in Australia – more than heart disease, cancer and diabetes combined.

23. Which form of Arthritis is it? • In diagnosing arthritis, a doctor will assess: • how the condition presents, • where the condition presents, • when the condition presents, • what makes it feel better, what makes it worse, • does it present as an acute episode or is there a chronic pattern?

24. 9

25. Osteoarthritis (OA) • Is the most common form of arthritis. • Accounts for 80% of all arthritis diagnoses. • Affects more than 1.8 million Australians. • Is an ‘old’ disease – dating to 4500BC. • Is the most common ailment of ancient man (and beast).

26. A healthy joint

27. What is happening in OA • OA is a degenerative disease. • Now we know that it is a complex mix of: • Biomechanics, • Biochemistry, and • Genetics. • Not just a natural consequence of ageing.

28. Osteoarthritis (OA) • Features of this condition: • degradation of/damage to the cartilage, meniscus • inflammation of the tissues around the joint including the bursa • development of bony spurs around joint edge • development of loss of strength in the muscles • development of weakness in the tendons and ligaments – causing instability.

29. Causes of OA in an Individual • May be: • Trauma or injury • Repetitive use or overuse • Genetics, including gender • Obesity. • Increases with age - related to, not caused by age. • Growing older increases the likelihood of OA.

30. Causes of OA in an Individual • Gender: • Research shows that women: • 45% higher risk of knee OA • 36% higher risk of hip OA • Lose cartilage 4 x faster than men. • Due to a combination of: • hormones, • bone structure, • cartilage volume & thickness, • more ‘elastic’ tendons.

31. Causes of OA in an Individual • Obesity: • Is a major factor in OA - particularly of weight bearing joints. • 1kg of additional weight = 4kg joint force. • Fat cells are active tissue that create and release chemicals. • These chemicals have been found to influence the development of OA. • Obesity plays systemic & mechanical • role in OA .

32. Demographics of OA • Although older age is the greatest risk factor for osteoarthritis - OA is not an inevitable consequence of growing old. • Radiographic changes of OA, particularly osteophytes, are common in the aged population, but symptoms of joint pain may be independent of radiographic severity in many older adults. • Age changes in the musculoskeletal system increase the propensity to OA but the joints affected and the severity of disease are most closely related to other OA risk factors such as joint injury, obesity, genetics and anatomical factors that affect joint mechanics.

33. Ageing and OA • although cartilage changes with age, the chemical changes that happen with OA are not part of the natural ageing process • getting older is one risk factor for developing OA • OA becomes more common with age, with peak onset 40-65years • significant symptoms of OA, in only 10% of people aged over 60 years.

34. Recap - How Osteoarthritis affects joints • joint space narrowing • structure and composition of the cartilage changes at a microscopic level • cartilage becomes rough & pitted • cartilage thins and develops tiny cracks • bone becomes ‘denser’ below the cartilage • defective repair process causes osteophytes • bone can also develop cysts and tiny fractures.

35. OA in a knee joint

36. Imaging of a knee joint with OA

37. A hip joint with OA

38. A joint we prepared earlier

39. Some joints we prepared earlier

41. Heberden'sNodes • These are hard swellings that develop in the distal interphalangeal joints of the fingers and toes. • They are a sign of OA and are caused by formation of osteophytes in response to repeated trauma to the joint. • They typically develop in middle age, over time develop bony outgrowth that can skew the fingertip sideways. • More common in women, and there seems to be a genetic predisposition. 10

42. Symptoms of OA • Affected joints & the associated tissues may have: • Pain (unilateral) • Localised swelling • Stiffness - after activity, after rest for approx 30 mins • Restricted range of joint movement • Joint instability • Decreased muscle tone and mass • Decreased muscle strength.

43. Pain in OA Joints • Pain in joints affected by OA is caused by: • bone grating on bone • pieces of bone and cartilage shearing off into the synovial cavity (joint space) • localised inflammation of the synovial membrane • pressure on and inflammation of the surrounding tissues • increased sensitivity caused by tiny factures in the bone ends.

44. Diagnosing OA • Doctors will assess many factors: • Patient symptoms – when, where, what, • Patient history, • Family history, • Patient Examination, • X-ray of affected joints (to exclude other types of arthritis), • Possibly blood tests or fluid from the joint. • ? MRI.

45. New Research into OA Bone Marrow Lesions – role in cartilage loss

46. Our Best Friends Get OA too...

47. A word on ‘rheumatism’ Rheumatism is a non specific term for medical conditions affecting the joints and connective tissues. Rheumatism is still used in colloquial speech or historical contexts but there is no longer any recognised disorder called ‘rheumatism’. The study of these disorders is still called rheumatology and medical specialists who care for people with arthritis and musculoskeletal conditions are called rheumatologists.

48. What other forms of arthritis do you know?

49. Other Types of Arthritis* • Inflammatory Arthritis – • refers to a ‘family’ of arthritic conditions including: • Rheumatoid Arthritis • Psoriatic Arthritis • Ankylosing Spondylitis • SjÖgren’s Syndrome • Polymyalgia Rheumatica • and • Juvenile Idiopathic arthritis. • * Just to name a few …………

50. Inflammatory Arthritis • These forms of arthritis: • Autoimmune diseases – caused by activation of the immune system • Systemic diseases – not just joints affected • Affect younger people (on the whole) • Have a significant genetic component • * Challenge the myth that arthritis is an old person’s disease.