الفهرس 
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Abstract
Osteoarthritis (OA)is one of the oldest and most common forms of arthritis it is the third most common diagnosis in the elderly , causes significant pain leading
to disability and decreased quality of life in subjects 65 years and older . it is acommon presentation in general practice,over 50% of people over the age of 65 years have radiological evidence of disease and approximately 10% of men and 18% of women have symptomatic OA &+70%of people over the age of 70 have x-ray evidence of osteoarthritis. About 13% of women and 10% of men aged 60 years and older have symptomatic knee OA. the
proportions of people affected with symptomatic knee OA is likely to increase due to the aging of the population and the rate of obesity or overweight in the
general population . During a one year period, 25% of people over 55 years may demonstrate persistent episode of knee pain, in whom about one in six have to consult their general practitioner about it in the same time period. About 10% of people aged over 55 years have painful disabling knee OA
of whom one quarter are severely disabled. Prevalence of knee OA in men
is lower compared with women .this was shown in a meta analysis of males and females in which the incidence of knee OA in males aged <55 years was
lower than females.
OA was previously considered to be a “wear and tear” degenerative process, affecting only articular cartilage.It is now described as a condition that has an effect on the whole joint unit.This includes the cartilage, periarticular bone, synovium/ capsule, ligaments, tendons and muscles. Causing stiffness, pain
and loss of movement in the joint,it also called osteoarthroses or degenerative joint disease. the pathological process involves fragmentation and thinning of articular cartilage, thickening of the subchondral bone, cyst formation, and the development of osteophytes, variable degrees of inflammation, ligamentous laxity and muscle weakness the interplay between various local and systemic factors, resulting in the development of OA. OA commonly weight-bearing and stressed joints (hips, knees and the first affects metatarsophalangeal joints), small hand joints and the cervica l and lumbar spine it is classified as primary or secondary. the cause of primary osteoarthritis is idiopathic; there is no obvious abnormality causing the
changes in the joint. secondary osteoarthritis is the result of a known cause, most often trauma/injury or systemic diseases. secondary osteoarthritis is
most often found in the shoulder, elbow, and ankle and is more likely to become clinically apparent at a younger age than primary osteoarthritis a thorough history and examination remains the most important aspect in the diagnosis of OA, as radiology and laboratory investigations may be normal .
Key features on history:
• Joint pain worse with activity.
• Morning stiffness lasting no more than 30 minutes.
• Stiffness after periods of immobility.
• Impairment of function.
Key features on examination:
• Bony swelling.
• Crepitus.
• Joint line tenderness.
• Limitation of joint mobility.
• Joint instability.
• Periarticular muscle atrophy.
• Joint effusions may be present
Assessment of patient with OA must be holistic approach involve the effect
Of osteoarthritis on the individual’s function, quality of life, occupation, mood,
relationships, and leisure activities .the cause of osteoarthritis- related pain
is not well understood the risk factors for osteoarthritis include sev¬eral
modifiable as well as nonmodifiable factors age, gender, and race/ethnicity influ¬ence the development of osteoarthritis at many joint sites.
Genetic predisposition is another non¬modifiable risk factor. among the modifiable risk factors, the greatest contributor to development of the disease
is overweight/obesity. Previous trauma/joint injury and specific sporting or occupational activities are other important risk factors. several other risk factors have been identified as potential contributors to the development of osteoarthritis. Among these a remalalignment, bone density, vitamin C and D
deficiency, and estrogen deficiency there is currently no curative therapy for
osteoarthritis, and treatments to alter or arrest the disease process are few
and mostly ineffective . thus, management is focused on decreasing pain and increasing functionand improved health related quality of life treatment. Should be tailored to each individual. and must be holistic approach.
The management of every patient should include the core treatments of education, exercise and interventions to reduce adverse mechanical factors (e.g. weight loss). there are effective non- pharmacological and
Pharmacological treatments available for the management of osteoarthritis nonpharmacological treatments should be tried first surgical intervention should be considered when medical treatment has failed . the effectiveness
therapeutic interventions can be assesses by Lequesne et al as in of appendix
2 prevention of osteoarthritis is important and necessary. this can be made identifying factors that increase the risk of osteoarthritis and intervening to reduce the occurrence of osteoarthritis by modifying these
risk factors and early diagnosis of osteoarthritis by screening of osteoarthritis but there are no screening guidelines or tests available for
early diagnosis of osteoarthritis. finally knee OA is a common and debilitate
-ing condition associated with pain and loss of mobility that undermines
quality of life in the elderly population. So there is a real need for effective,
safe, especially in the elderly, disease modifying OA therapies that can not only effectively treat those with established OA, but also possibly delay or prevent progression in those with early OA as well as Maintaining or restoring functional capacity in elderly.
Cartilage replacement by bone marrow stem cells and implantation of autologous chondrocytes or bioengineered tissues continue as important
areas of. therapeutic interest.