Diseases, Disorders information

Metabolic factors: certain metabolic diseases are associated with an increased incidence of osteoarthritis. Acromegaly, for instance. Obviously this is very uncommon but there may be more common subtle metabolic factors that play a role in the development of primary osteoarthritis.
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Neurologic factors: this is a disease of older patients. It’s unusual to see a primary osteoarthritis in patients under age 50. What happens when people age is that things just don’t work as well as they used to, in general, and the neurologic system is no different. This is becoming an area of great interest to several of the major centers studying osteoarthritis. Actually, if you look at the number of centers studying osteoarthritis it is much less common. So unfortunately it’s not a disease that rheumatologists and orthopedists are always that interested in, even though it is much more common. But these neurologic factors may be a subtle loss of proprioception or some weakness of some muscles that help support the joint, and people have shown that these things do occur and certain measures can affect that and make the patients symptomatically better. Aging and obesity, clearly osteoarthritis is associated with aging, but whether it is the cause of it is not clear. And obesity; there have been a number of studies. It’s hard to show that obesity actually causes osteoarthritis but certainly if someone weighs 450 pounds there is going to be a lot more stress on their knees, and especially their hips. So it does appear to be an aggravating factor but whether or not it’s a primary cause is not clear.
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Of course osteoarthritis can occur secondarily to other diseases. Trauma. Someone who had a broken hip or a torn anterior cruciate ligament may be predisposed to develop osteoarthritis in that joint later. Inflammation, either chronic inflammation as in rheumatoid disease or acute inflammation, as in a patient with septic arthritis that just didn’t respond well or get treated adequately. Again, metabolic factors, AVN, avascular necrosis, sometimes by the time you see the patient you can’t tell what the cause was in a single joint, but maybe they have a history of AVN in another joint. Of course if you follow a patient with AVN that is very early in the course and you don’t operate right away, they will eventually develop osteoarthritis in that joint. Neurologic disorders, less subtle, such as syringomyelia where you get neuropathic joints, which is just basically a very severe degenerative process. Obviously, congenital or developmental defects. We followed one patient with spondylo-epiphyseal dysplasia, or something like that, and she has abnormalities in the structure of many of her joints, particularly the hip and the back, and I think the knees, and she’s had several joint replacements because this disorder that she was basically born with basically leads to premature osteoarthritis. There are a number of other rarer diseases that can occur and then predispose to osteoarthritis. I think one common thing that pediatricians may see is hip dysplasia, and if that’s not treated properly, those patients get an osteoarthritic joint. If it’s treated properly then the acetabular cup forms normally and the children do much better.