Rapidly Progressing Osteoar -thritis and Methods for Evaluation of its Progression

Overview

Osteoarthritis (OA) is a heterogeneous clinical syndrome with a different rate of progression. In themajority of patients osteoarthritis progresses very slowly, in the minority OA leads however rapidlyto destruction of the cartilage with the necessity of a surgical intervention. Progression of osteoar-thritis can be evaluated from different aspects such as various subjective indicators (evaluation ofpain or general status assessed by means of questionnaires), semiobjectively (clinical finding,assessment of articular function) or objectively, i.e. by imaging methods (X-ray, sonography, MR,scintigraphy by means of 99m Tc labelled biphosphonates) or using biological markers of bone andcartilage degradation. The basic method for evaluation of the progression of osteoarthritis ismeasurement of the joint space width. While the mean loss of cartilage in common progressingosteoarthritis of the knee and hip joints varies in different studies within the range from 0.06–0.6mm/year, as the rapidly progressing form we classify nowadays a joint space narrowing greater than1 mm/year. It was found that rapidly progressing OA is more frequent in advanced age groups (above65 years), in women, in obese patients, in heavy workers, in patients with generalized OA and withfrequent inflammatory irritations. The familial incidence of this disease was als o described. It ismanifested more frequently in the hip joints than the knees. A common complication of the diseaseis osteonecrosis. Predictive factors of rapid progression are not known, the value of assessment ofbiochemical markers of cartilage (e.g. COMP) or the value of bone scintigraphy are contemplated.Causal treatment of rapidly progressing OA is not known. The basis of treatment are lifestyleprovisions and the administration of non-steroid antiphlogistics and analgesics. Despite this therapythe patients require replacement of the affected joint within a period of several months to 2–3 years.

Key words:
rapidly progressing osteoarthritis, evaluation of progression, joint space width