What are the other Names for this Condition? (Also known as/Synonyms)

• Secondary OA

What is Secondary Osteoarthritis? (Definition/Background Information)

• Osteoarthritis (OA) is a painful joint disorder characterized by the progressive degeneration of the articular cartilage that covers the bone surface of joints
• Secondary Osteoarthritis develops from factors such as overuse of the joint from work or sporting activities, injury to the joints, obesity, underlying health conditions (such as gout or rheumatoid arthritis), and genetic disorders (such as Wilson’s disease)
• Unlike primary osteoarthritis, which is due to advancing age and observed in slightly older adults, the onset of Secondary Osteoarthritis is observed in a slightly younger age group (in individuals over the age of 45 years)
• Secondary Osteoarthritis is a gradual progressive degenerative disorder that affects any joint(s) in the body. The condition may be aided adversely by factors such as aging, causing joint wear and tear, and one’s genetic susceptibility
• Individuals who develop the condition begin to experience pain and stiffness in the joint that usually increase with time. Secondary Osteoarthritis can result in a decreased quality of life due to permanent joint immobility
• Early and adequate treatment is necessary to control the progression of Secondary Osteoarthritis. The treatment associated with the condition includes both nonsurgical and surgical methods. The prognosis is good with early treatment in a majority of individuals

Who gets Secondary Osteoarthritis? (Age and Sex Distribution)

• Secondary Osteoarthritis may occur in individuals of all age, race, ethnic group, and belonging to any gender
• The onset of symptoms are generally observed around or after age 45 years
• Middle-aged men and young athletes, who sustain traumatic joint injuries (while participating in rough or high-impact sports activities), are higher prone to developing this condition

What are the Risk Factors for Secondary Osteoarthritis? (Predisposing Factors)

The risk factors for Secondary Osteoarthritis include:

• Prior joint injury or infection
• Rheumatoid arthritis
• systemic lupus erythematosus
• Acromegaly
• Hemochromatosis
• Synovial osteochondromatosis (knee and hip)
• Secondary syphilis
• Lyme disease
• Ankylosing spondylitis 
• Many of the autoinflammatory diseases, such as systemic juvenile idiopathic arthropathy, Behçets disease, and adult-onset Still’s disease
• Gout and pseudogout: Medical conditions caused by a high level of uric acid or calcium pyrophosphate crystals in the joint spaces
• Wilson’s disease: A copper transport disease with prominent liver and neurologic findings. Wilson’s disease patients also have an increased risk of knee and spine osteoarthritis
• Alkaptonuria
• Psoriatic arthritis
• Avascular necrosis
• Paget’s disease of bone: A rare and chronic bone disorder characterized by abnormal growth and deformity of bones, also leading to osteoarthritis
• Hypermobility Syndromes lead to increased range of motion at joints. This excessive mobility leads to increased wear and tear on cartilage, thence early onset secondary osteoarthritis. Some conditions are hereditary, such as Ehlers-Danlos syndrome, Marfan syndrome, Stickler syndrome, osteogenesis imperfecta, and others. Down’s syndrome, cerebral palsy, and disorders leading to poor muscle tone also lead to increased joint motion
• Hypothyroidism: A medical condition characterized by the body’s inability to produce enough thyroid hormone
• Individuals with poorly-controlled diabetes; it is a chronic medical condition characterized by excessive levels of sugar in blood
• Genetic disorders that cause improper formation of the joints
• Certain neuromuscular disorders

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Secondary Osteoarthritis? (Etiology)

Secondary Osteoarthritis develops from the gradual wear and tear of joints in the body that occur with various factors such as joint overuse and injury. In this condition, there is a wearing away of the cartilage with associated bone changes. Some of the factors that play a role include:

• Any injury to the joint sustained while participating in sports, such as football, tennis, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding
• Repetitive stress on the joint from certain occupations, such as carpentry or painting
• Obesity, causing abnormal stress on the joints
• Progressive damage of the joint cartilage due to an underlying health condition

In contrast, primary osteoarthritis is a degenerative condition of joints seen progressively with age in the absence of specific secondary triggers or accelerators of osteoarthritis. If none of the causes of Secondary Osteoarthritis are diagnosed, primary osteoarthritis is generally the default diagnosis.

What are the Signs and Symptoms of Secondary Osteoarthritis?

Secondary Osteoarthritis is gradual degenerative disorder that usually worsens over time. The common signs and symptoms of the condition include:

• Noticeable pain and tenderness in the affected joint
• Swelling in the region
• Stiffness and reduced mobility of the joint
• Formation of bone spurs around the joint
• Any joint of the body may be affected

How is Secondary Osteoarthritis Diagnosed?

Diagnostic methods that a physician may use to help diagnose Secondary Osteoarthritis may include:

• Physical examination: The physician will perform a thorough physical examination to determine, if the individual has osteoarthritis. In addition to this, a complete medical history may aid in arriving at a diagnosis
• X-ray of the affected joint: X-rays use radiation in order to produce images of the joint, which can help the physician rule out other possible causes for pain and discomfort
• Various blood tests to rule-out other conditions that may cause similar symptoms
• Joint fluid analysis of affected joint: Occasionally, fluid may accumulate around a joint. Analysis of this fluid will give clues regarding the cause of the joint fluid accumulation, which causes pain and disability. A needle is inserted into the joint space, and the accumulated fluid aspirated with a syringe. It is then sent to a laboratory for analysis to determine:
  • The type of cells present in the fluid
  • Chemical composition of the fluid
  • The presence of crystals (examination of fluid under a microscope)
• If an infection is suspected as the cause of accumulation of the joint fluid, then a joint fluid culture may be performed. The culture of joint fluid will confirm an infection of the elbow joint as the cause of arthritis (termed infective arthritis)
• Ultrasound imaging of joint: The use of high-frequency sound waves to generate a thorough image of the affected joint
• CT, MRI scan of the affected joint

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Secondary Osteoarthritis?

Secondary Osteoarthritis is a progressive condition that gradually worsens over time. The complications of the condition may include:

• Chronic pain and stiffness within the joint, which may prevent individuals from performing their daily routine activities
• Permanent disability
• Decreased quality of life

How is Secondary Osteoarthritis Treated?

The treatment of Secondary Osteoarthritis includes nonsurgical and surgical methods. A healthcare provider may start with non-surgical treatment methods before adopting surgical procedures and techniques. These include:

• For Secondary Osteoarthritis, optimal control of the disease or condition (if possible) 

causing early-onset osteoarthritis is a key treatment goal

• Rest: Any activity that aggravates the joint condition further should be avoided. The physician usually advises to refrain from all such activities until the symptoms stop
• Heat and ice: Applying a damp heated towel or ice to the joint can help reduce pain and swelling
• Splint or brace: A physician may prescribe some type of padded splint or cast to help keep the joint in a stable position, especially while sleeping
• Non-steroidal anti-inflammatory medication: Medications, such as ibuprofen and naproxen, can help decrease the joint pain and swelling
• Corticosteroid medications, such as prednisone, help provide temporary relief of symptoms and improve the range of motion within the joint. Corticosteroids can be given systemically or injected directly into a specific affected joint. It is important to note that corticosteroid injections may only give temporary relief. Repetition of such injections can ultimately lead to further joint injury
• Viscosupplementation: Normal fluid within a joint contains a material called hyaluronic acid. When a joint is affected by osteoarthritis, a reduction of hyaluronic acid levels occurs within the joint. Such a decreased acid level will decrease the ability of the joints to lubricate. Viscosupplementation is a minimally-invasive technique that is commonly used when treating osteoarthritis. During this procedure, small doses of hyaluronic acid are injected into the arm/leg to relieve pain
• Physical therapy: After the symptoms have decreased, it is important to begin some light motion exercises. Physical therapy may help restore strength, as well as provide flexibility to the muscles

Surgical treatment measures include:

• Joint fusion: Joint fusion is a surgical technique that involves the removal of the arthritic part within the joint and fusing two surrounding bones together. The purpose of this procedure is to relieve pain, stabilize the joint, and regain some range of motion in the affected joint
• Total arthroplasty: It is a surgical intervention tool in which the joint is completely removed. The arthritic joint that is removed is then replaced by a metal and plastic prosthetic implant. A physician will recommend this surgical procedure if the degenerative disorder affects the entire joint

How can Secondary Osteoarthritis be Prevented?

A few recommendations to help prevent Secondary Osteoarthritis include:

• Individuals who maintain a healthy diet may decrease the chance of developing this condition
• Some evidence exists that adherence to the Mediterranean diet leads to improvement in  osteoarthritis (Reference: Osteoarthritis and the Mediterranean Diet: A Systematic Review https://doi.10.3390/nu10081030)
• Estrogen replacement therapy can decrease the incidence of osteoarthritis after menopause in women
• Using correct posture and tools that decrease stress on joints in the workplace can decrease the incidence of the condition due to occupational causes
• Undertake a proper treatment of gout
• Prompt and adequate treatment of individuals with Paget’s disease
• In individuals with hypothyroidism, prompt treatment of the thyroidal condition
• Proper treatment of diabetes
• Maintaining a healthy body weight can help prevent abnormal pressure on the joints
• Individuals who participate in any high-risk sports, such as football and basketball, should wear appropriate safety gear to help prevent serious injuries to their joints

What is the Prognosis of Secondary Osteoarthritis? (Outcomes/Resolutions)

The long term prognosis of Secondary Osteoarthritis depends on the severity of this degenerative condition.

• If it is detected early and proper aggressive treatment is provided, then the prognosis is good in a majority of individuals if no serious complications are noted
• In general, without treatment, a high percentage of individuals who develop this condition may experience a lifetime of gradual degeneration that can be debilitating

Additional and Relevant Useful Information for Secondary Osteoarthritis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/