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Osteoartrose

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Osteoartrite, osteoartrose, idoso, limitação funcional

Publicada em: Saúde e medicina
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Osteoartrose

  1. 1. Virgílio Garcia Moreira MD MPh
  2. 2. Prevalência de 37% - EUA > 55 anos de 44 a 70% evidencias radiológicas de OA 4/100 de 18 a 24 anos 85/100 de 75 a 79 anos Autopsias Indivíduos 40 anos 90% OA Lawrence RC, Helmick CG, Arnett FC, et al. Estimatesof prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41: 778–799.
  3. 3. Idade Avançada A Quarta Idade
  4. 4. Garcez-Leme, Luiz E., Deckers Leme, Mariana & Espino, David V. (2005). Geriatrics in Brazil: A Big Country with Big Opportunities. Journal of the American Geriatrics Society 53 (11), 2018-2022.
  5. 5. Acima 50 anos Acima 40 anos Após Menopausa 4 mulheres/ 1 homem Stevens, MB. Connective tissue disease in the elderly. Clin Rheum Dis. 1986;12:11–32.
  6. 6. Estudo de Framinham: - 27% < 70 anos OA Joelhos; - 44% > 80 anos OA Joelhos; Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum. 1990;20:34– 41.
  7. 7. Traumas de Repetição Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum. 1990;20:34– 41.
  8. 8. Atividades Ocupacionais Davis MA, Ettinger WH, Neuhaus JM. Obesity and osteoarthritis of the knee: evidence from the National Health and Nutrition Examination Survey (NHANES I). Semin Arthritis Rheum. 1990;20:34– 41.
  9. 9. Obesidade Fernando Botero
  10. 10. Sistema Muscular Proteção Fraqueza Muscular Causa x Consequência A. Vesalius 1514-64
  11. 11. Evidência Pré-histórica Australopithecus aferensus Masmejean E, Dutour O, Touam C, et al. Bilateral SLAC (scapholunate advanced collapse) wrist: an unusual entity. Apropos of a 7000-year-old prehistoric case. Ann Chir Main Membre Super. 1997;16:207–214.
  12. 12. Definição  Doença degradativa crônica que se inicia na cartilagem articular e sofre influências genéticas e mecânicas locais  Caracterizada por :degradação da cartilagem articular remodelação óssea com eburneação óssea subcondral e formação osteofitária Fitzgerald GK, Piva SR, Irrgang JJ. Reports of joint instability in knee osteoarthri- tis: its prevalence and relationship to physical function. Arthritis Rheum. 2004;51(6):941–946.
  13. 13. Classificação Primária ou Idiopática: - Localizado - Generalizado Mono Oligo Poliarticular
  14. 14. Classificação Secundária: - Hiperuricemia - Artrite Reumatóide - Bacteriana - Manifestações de Doenças Orgânicas
  15. 15. Critérios Diagnósticos Idade Sintomas Imagem Focais Hazard, W. & col. Principles of Geriatric and Gerontology. 6º Ed. 2009 - MCGrawn Hill.
  16. 16. Fisiopatologia Avascular Aneural
  17. 17. Dieppe e Brandt. What is important in treating osteoarthritis?Whomshould we treat and how should wetreat them?. Rheumatic Disease Clinics of North America (2003) vol. 29 pp. 687-716
  18. 18. Fisiopatologia
  19. 19. Dieppe e Lohmander. Pathogenesis and management of pain in osteoarthritis. Lancet (2005) vol. 365 (9463) pp. 965-73
  20. 20. Fisiopatologia
  21. 21. Fisiopatologia
  22. 22. Fisiopatologia Degradação Reparo Loeser RF. Molecular mechanisms of cartilage destruction: mechanics, inflammatory mediators and aging collide. Arthritis Rheum. 2006;54(5):1357–1360.
  23. 23. Clínica  Dor e sensibilidade á mobilização,palpação e manobras  Crepitação palpável e, excepcionalmente, audível  Espasmo e atrofia da musculatura articular  Limitação da ADM  Sinais discretos de inflamação articular,raramente acentuados  Derrame articular, comumente relacionado com trauma ou uso excessivo da articulação
  24. 24. Exame Físico
  25. 25. Exame Físico
  26. 26.  Mãos  principal sítio de acometimento
  27. 27. Acometimento simétricos 2º E 5º DEDOS + precoce SEXO ♀5ªdécada NÓDULOS deBOUCHARD IF PROXIMAIS NÓDULOS de HEBERDEN IF DISTAIS
  28. 28. Nódulos de Heberden Nódulos de Bouchard
  29. 29.  Quadris  Segundo sítio de maior comprometimento
  30. 30. SEXO ♂ Dor insidiosa piora gradativamente surgindo dificuldade para caminhar subir e descer escadas contratura em flexão e adução dor irradiada para face posterior da coxa ou anterior até o joelho Dor poderá se tornar constante ,noturna com incapacidade funcional
  31. 31.  Joelhos  Terceiro sítio de acometimento
  32. 32. GONARTROSE SEXO♀ 5ª década Simétricos relação Obesidade Atitude no trabalho Joelho varo ou valgo Exame Físico : Edema Limitação Deformidade Crepitação Derrame
  33. 33. Disco intervertebral Corpo vertebral Art /apofisárias IDADE 41 a 60 anos Dor localizada ligamentos cápsulas e músculos Dor irradiada por compressão radicular Piora com os movimentos Melhora com o repouso
  34. 34. Laboratório  PCR  VHS  Marcadores de Citocinas Pelletier JP, Martel-Pelletier J. New trends in the treatment of osteoarthritis. Semin Arthritis Rheum. 2005;34(6 Suppl 2):13–14.
  35. 35. Raio X Ressonância
  36. 36. - Alinhamento Juncional - Espaço articular - Calcificações adjacentes (peri e intra articular) - Osteopenia - Fraturas - Cistos condrais - Esclererose subcondral
  37. 37. Espaço articular Alinhamento Osteopenia Calcificações
  38. 38. Objetivos 1- Idade 2- Comorbidades 3- Severidade Clínica da OA 4- Preferênias Individuais 5- Custos Dieppe e Brandt. What is important in treating osteoarthritis?Whomshould we treat and how should wetreat them?. Rheumatic Disease Clinics of North America (2003) vol. 29 pp. 687-716
  39. 39. Corrigir Fatores de Risco Deformidades Sobrecarga Articular Repouso quando grande algia Orteses Terapia Física – Calor local
  40. 40. Educação, estilo de vida e Comportamento - Educação do paciente e familiares - “Empowerment” - Mudanças ambientais - Atividade Física - Perda de Peso e orientações dietéticas - Avaliação dos pés e calçados Dieppe e Brandt. What is important in treating osteoarthritis?Whomshould we treat and how should wetreat them?. Rheumatic Disease Clinics of North America (2003) vol. 29 pp. 687-716
  41. 41. Práticas Não Farmacológicas - Exercícios (mobilidade, força, função – redução da Dor - Aparatos de proteção - Nutracêuticos - Acupuntura** Dieppe e Brandt. What is important in treating osteoarthritis?Whomshould we treat and how should wetreat them?. Rheumatic Disease Clinics of North America (2003) vol. 29 pp. 687-716
  42. 42. Dieppe e Brandt. What is important in treating osteoarthritis?Whomshould we treat and how should wetreat them?. Rheumatic Disease Clinics of North America (2003) vol. 29 pp. 687-716
  43. 43. Dieppe e Brandt. What is important in treating osteoarthritis?Whomshould we treat and how should wetreat them?. Rheumatic Disease Clinics of North America (2003) vol. 29 pp. 687-716
  44. 44. Cirurgia parcial ou total Osteotomia, superficialização Intervenções não cirúrgicas – Iinfusões locais AINE Fisioterapia, Órteses Analgesia tópica, nutraceuticos, estilo de vida Recomendações Gerais Educação, perda de peso, exercícios, alteração do estilo de vida Consultas Amiúde Severidade Número de Indivíduos

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