Post-traumatic arthritis explained

Post-traumatic arthritis
Synonym:Post-traumatic osteoarthritis, post-traumatic inflammatory arthritis
Specialty:Orthopedics
Symptoms:stiffness, swelling, synovial effusion, pain, redness, tenderness, grinding, instability, intra-articular bleeding
Types:Post-traumatic osteoarthritis, post-traumatic inflammatory arthritis
Causes:Physical injury
Risks:Overweight, physical activity, injuries
Diagnosis:Medical history, X-ray
Treatment:Medication, surgery, physical therapy
Medication:NSAIDs, cortisone, paracetamol, corticosteroid
Frequency:Over 5.6 million people in the US

Post-traumatic arthritis (PTAr) is a form of osteoarthritis following an injury to a joint.[1]

Classification

Post-traumatic arthritis is a form of osteoarthritis and the former can occur after the latter. However, post-traumatic arthritis can also occur after the development of chronic inflammatory arthritis.

Generally, post-traumatic arthritis is classified in two groups: post-traumatic osteoarthritis and post-traumatic inflammatory arthritis.

Post-traumatic osteoarthritis

Post-traumatic osteoarthritis is the most common variation of post-traumatic arthritis.[2] Between 20 and 50%[3] of all osteoarthritis cases are preceded by post-traumatic arthritis. Patients having post-traumatic osteoarthritis are usually younger than osteoarthritis patients without any previous physical injuries.[4]

Post-traumatic inflammatory arthritis

Less common is post-traumatic inflammatory arthritis, accounting for between 2 and 25% of all post-traumatic arthritis cases.[5] There are reports about a connection between previous physical injury and inflammatory arthritis, such as rheumatoid arthritis[6] [7] or psoriatic arthritis.[8] [9]

Signs and symptoms

The symptoms of post-traumatic arthritis are similar to the ones occurring with osteoarthritis. General symptoms are stiffness, swelling, synovial effusion, pain, redness, tenderness, grinding, instability and intra-articular bleeding of the injured joint.[1] [10]

As a result of these symptoms, post-traumatic arthritis often comes along with the loss of ability.

Risk factors

Since post-traumatic arthritis usually occurs after injuring a joint, the risk of having post-traumatic arthritis after such an injury is significantly higher.Risk factors which increase the danger of getting post-traumatic arthritis are being overweight and physical activity.[11] The prevalence of post-traumatic arthritis is much higher when doing heavy work and overusing the injured joints.Examinations also revealed that a body mass index (BMI) increase of five units results in a 35% higher risk of post-traumatic arthritis.[12]

It is reported that genetics do have an influence on the prevalence of post-traumatic arthritis.[13] [14] According to newer examinations, the sex of the patients may also have an influence on post-traumatic arthritis, since females are affected by post-traumatic arthritis more frequently than males.[15]

Pathogenesis

The process of post-traumatic arthritis can be divided into three phases: immediate, acute, and chronic.[1] [16]

Immediate phase

This phase usually begins a few seconds after the injury; it is characterized by cell necrosis, collagen rupture, swelling of the cartilage, hemarthrosis, and the loss of glycosaminoglycans (GAGs).[1] [17]

Acute phase

In this phase, acute post-traumatic arthrosis emerges. Matrix degradation, leukocyte infiltration, inflammatory mediators, deficient lubricants, and apoptosis can occur. Typically, the acute phase comes hours after the injury.[1] [18]

Chronic phase

The chronic phase occurs months or years after the trauma. Typical symptoms are joint pain and dysfunction.[1] [11]

Diagnosis

Post-traumatic arthritis is diagnosed with the help of a patient's medical history. Additionally, radiographic imaging can assist in diagnosing post-traumatic arthritis.[19]

Management

It is not possible to cure the acute post-traumatic arthritis in order to prevent a chronic post-traumatic arthritis.[1] There are many different options to manage chronic post-traumatic arthritis.[11]

Lifestyle

Since being overweight is a risk factor for post-traumatic arthritis, lifestyle changes that help manage body weight are important in the treatment and prevention of the condition. Lifestyle changes and weight loss often involve educating the affected person about how to practice a healthy lifestyle.[20]

Therapeutic measures

Physical therapy may help reduce pain and other symptoms of post-traumatic arthritis.[21] The efficacy of massage therapy[22] and manual therapy[23] are not yet proven.[21] [22] [23]

Medication

Post-traumatic arthritis is treated symptomatically with nonsteroidal anti-inflammatory drugs (NSAIDs).[1] [11] For more moderate symptoms, paracetamol is also used.[24] [25] Another medical treatment approach is the injection of cortisone or corticosteroid into the affected joint.[1] [26]

Surgery

If medications, lifestyle changes, and physical therapy are not enough to reduce the symptoms, especially the pain, surgery and other such interventions for managing post-traumatic arthritis are available. In many cases, joint replacement or cartilage resurfacing are recommended. As clinical studies have demonstrated, such surgical methods can be effective at reducing symptomatic pain[27] [28] and the costs associated with management of the condition.[29] [30]

Epidemiology

About 12% of all osteoarthritis cases in the United States are classified as post-traumatic osteoarthritis.[31] This means that over 5.6 million people are affected by post-traumatic osteoarthritis only in the United States.[31] Females are more often affected than males.[15]

Post-traumatic arthritis costs the US health care system approximately 3.06 billion (0.15%) of total health care costs each year.[31]

Notes and References

  1. Punzi. Leonardo. Galozzi. Paola. Luisetto. Roberto. Favero. Marta. Ramonda. Roberta. Oliviero. Francesca. Scanu. Anna. 6 September 2016. Post-traumatic arthritis: overview on pathogenic mechanisms and role of inflammation. RMD Open. 2. 2. e000279. 10.1136/rmdopen-2016-000279. 5013366. 27651925.
  2. Muthuri. S.G.. McWilliams. D.F.. Doherty. M.. Zhang. W.. 2011-11-01. History of knee injuries and knee osteoarthritis: a meta-analysis of observational studies. Osteoarthritis and Cartilage. en. 19. 11. 1286–1293. 10.1016/j.joca.2011.07.015. 21884811. free.
  3. Lohmander. L. Stefan. Englund. P. Martin. Dahl. Ludvig L.. Roos. Ewa M.. October 2007. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. The American Journal of Sports Medicine. 35. 10. 1756–1769. 10.1177/0363546507307396. 17761605.
  4. Gelber. A. C.. Hochberg. M. C.. Mead. L. A.. Wang. N. Y.. Wigley. F. M.. Klag. M. J.. 2000-09-05. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Annals of Internal Medicine. 133. 5. 321–328. 10979876. 10.7326/0003-4819-133-5-200009050-00007.
  5. Williams. K A. Scott. J T. November 1967. Influence of trauma on the development of chronic inflammatory polyarthritis. Annals of the Rheumatic Diseases. 26. 6. 532–537. 1010439. 6066236. 10.1136/ard.26.6.532.
  6. Söderlin. Maria K.. Bergsten. Ulrika. Svensson. Björn. BARFOT Study Group. March 2011. Patient-reported events preceding the onset of rheumatoid arthritis: possible clues to aetiology. Musculoskeletal Care. 9. 1. 25–31. 10.1002/msc.193. 21351367.
  7. Malleson. P. May 1997. Management of childhood arthritis. Part 1: acute arthritis. Archives of Disease in Childhood. 76. 5. 460–462. 1717186. 9196369. 10.1136/adc.76.5.460.
  8. Olivieri. Ignazio. Padula. Angela. D'Angelo. Salvatore. Scarpa. Raffaele. November 2008. Role of trauma in psoriatic arthritis. The Journal of Rheumatology. 35. 11. 2085–2087. 10.3899/jrheum.080668. 19004049. free.
  9. Punzi. L.. Pianon. M.. Bertazzolo. N.. Fagiolo. U.. Rizzi. E.. Rossini. P.. Todesco. S.. May 1998. Clinical, laboratory and immunogenetic aspects of post-traumatic psoriatic arthritis: a study of 25 patients. Clinical and Experimental Rheumatology. 16. 3. 277–281X. 9631749.
  10. Web site: Post Traumatic Wrist Arthritis Orthopaedic Surgery Michigan Medicine University of Michigan. medicine.umich.edu. en. 2018-03-28.
  11. Anderson. Donald D.. Chubinskaya. Susan. Guilak. Farshid. Martin. James A.. Oegema. Theodore R.. Olson. Steven A.. Buckwalter. Joseph A.. 2011-06-01. Post-traumatic osteoarthritis: Improved understanding and opportunities for early intervention. Journal of Orthopaedic Research. en. 29. 6. 802–809. 10.1002/jor.21359. 21520254. 3082940.
  12. Jiang L, Tian W, Wang Y, Rong J, Bao C, Liu Y, Zhao Y, Wang C. Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis. Joint Bone Spine . 79. 3. 291–7. May 2012. 21803633. 10.1016/j.jbspin.2011.05.015.
  13. Valdes. Ana M. Doherty. Sally A. Muir. Kenneth R. Wheeler. Margaret. Maciewicz. Rose A. Zhang. Weiya. Doherty. Michael. The genetic contribution to severe post-traumatic osteoarthritis. Annals of the Rheumatic Diseases. 72. 10. 1687–1690. 10.1136/annrheumdis-2012-202562. 3786638. 23355107. 2013.
  14. Spector TD, MacGregor AJ. Risk factors for osteoarthritis: genetics. Osteoarthritis and Cartilage. 12 Suppl A. S39–44. 2004. 14698640. 10.1016/j.joca.2003.09.005. free.
  15. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clinics in Geriatric Medicine. 26. 3. 355–69. August 2010. 20699159. 2920533. 10.1016/j.cger.2010.03.001.
  16. Lieberthal. Jason. Sambamurthy. Nisha. Scanzello. Carla R.. Inflammation in Joint Injury and Post-Traumatic Osteoarthritis. Osteoarthritis and Cartilage. 23. 11. 1825–1834. 10.1016/j.joca.2015.08.015. 4630675. 26521728. 2015.
  17. Swärd. P.. Frobell. R.. Englund. M.. Roos. H.. Struglics. A.. November 2012. Cartilage and bone markers and inflammatory cytokines are increased in synovial fluid in the acute phase of knee injury (hemarthrosis)—a cross-sectional analysis. Osteoarthritis and Cartilage. 20. 11. 1302–1308. 10.1016/j.joca.2012.07.021. 22874525. free.
  18. Heard. B. J.. Solbak. N. M.. Achari. Y.. Chung. M.. Hart. D. A.. Shrive. N. G.. Frank. C. B.. December 2013. Changes of early post-traumatic osteoarthritis in an ovine model of simulated ACL reconstruction are associated with transient acute post-injury synovial inflammation and tissue catabolism. Osteoarthritis and Cartilage. 21. 12. 1942–1949. 10.1016/j.joca.2013.08.019. 24012772. free.
  19. Bierma-Zeinstra. Sita M. A.. Oster. J. Dorinde. Bernsen. Roos M. D.. Verhaar. Jan A. N.. Ginai. Abida Z.. Bohnen. Arthur M.. August 2002. Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care. The Journal of Rheumatology. 29. 8. 1713–1718X. 12180735.
  20. Cibulka. Michael T.. White. Douglas M.. Woehrle. Judith. Harris-Hayes. Marcie. Enseki. Keelan. Fagerson. Timothy L.. Slover. James. Godges. Joseph J.. Hip Pain and Mobility Deficits – Hip Osteoarthritis. The Journal of Orthopaedic and Sports Physical Therapy. 39. 4. A1–25. 10.2519/jospt.2009.0301. 3963282. 19352008. 2009.
  21. Wang. Shi-Yi. Olson-Kellogg. Becky. Shamliyan. Tatyana A.. Choi. Jae-Young. Ramakrishnan. Rema. Kane. Robert L.. 2012-11-06. Physical Therapy Interventions for Knee Pain Secondary to Osteoarthritis: A Systematic Review. Annals of Internal Medicine. en. 157. 9. 632–44. 10.7326/0003-4819-157-9-201211060-00007. 23128863.
  22. De Luigi. Arthur Jason. May 2012. Complementary and alternative medicine in osteoarthritis 1. PM&R: The Journal of Injury, Function, and Rehabilitation. 4. 5 Suppl. S122–133. 10.1016/j.pmrj.2012.01.012. 22632691.
  23. French. H. P.. Brennan. A.. White. B.. Cusack. T.. April 2011. Manual therapy for osteoarthritis of the hip or knee – A systematic review. Manual Therapy. 16. 2. 109–117. 10.1016/j.math.2010.10.011. 21146444.
  24. Flood J. The role of acetaminophen in the treatment of osteoarthritis. The American Journal of Managed Care. 16 Suppl Management. S48–54. March 2010. 20297877.
  25. Zhang. W.. Moskowitz. R. W.. Nuki. G.. Abramson. S.. Altman. R. D.. Arden. N.. Bierma-Zeinstra. S.. Brandt. K. D.. Croft. P.. September 2007. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis and Cartilage. 15. 9. 981–1000. 10.1016/j.joca.2007.06.014. 17719803. free.
  26. Arroll. Bruce. Goodyear-Smith. Felicity. 2004-04-10. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 328. 7444. 869. 10.1136/bmj.38039.573970.7C. 15039276. 387479.
  27. Santaguida . Pasqualina L. . Hawker . Gillian A. . Gillian Hawker . Hudak . Pamela L. . Glazier . Richard . Mahomed . Nizar N. . Kreder† . Hans J. . Coyte . Peter C. . Wright . James G. . 2008 . Patient characteristics affecting the prognosis of total hip and knee joint arthroplasty: a systematic review . Canadian Journal of Surgery . 51 . 6 . 428–436X . 2592576 . 19057730.
  28. Carr. Andrew J. Robertsson. Otto. Graves. Stephen. Price. Andrew J. Arden. Nigel K. Judge. Andrew. Beard. David J. 2012-04-07. Knee replacement. The Lancet. en. 379. 9823. 1331–40. 10.1016/S0140-6736(11)60752-6. 22398175.
  29. Jenkins. P. J.. Clement. N. D.. Hamilton. D. F.. Gaston. P.. Patton. J. T.. Howie. C. R.. January 2013. Predicting the cost-effectiveness of total hip and knee replacement: a health economic analysis. The Bone & Joint Journal. 95-B. 1. 115–121. 10.1302/0301-620X.95B1.29835. 23307684.
  30. Daigle. Meghan E.. Weinstein. Alexander M.. Katz. Jeffrey N.. Losina. Elena. The cost-effectiveness of total joint arthroplasty: a systematic review of published literature. Best Practice & Research. Clinical Rheumatology. 26. 5. 649–58. 10.1016/j.berh.2012.07.013. 3879923. 23218429. 2012.
  31. Brown. Thomas D.. Johnston. Richard C.. Saltzman. Charles L.. Marsh. J. Lawrence. Buckwalter. Joseph A.. November 2006. Posttraumatic Osteoarthritis: A First Estimate of Incidence, Prevalence, and Burden of Disease. Journal of Orthopaedic Trauma. en-US. 20. 10. 739–44. 10.1097/01.bot.0000246468.80635.ef. 17106388.

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