Diz Osteoartriti
Özet
Diz osteoartriti (DOA), eklem kıkırdağının yıkımı, subkondral skleroz, osteofit oluşumu ve sinovit ile karakterize, yük taşıyan eklemleri etkileyen düşük dereceli kronik inflamatuar bir halk sağlığı sorunudur. Küresel epidemiyolojik veriler, semptomatik diz osteoartriti prevalansının kadınlarda erkeklere oranla anlamlı derecede yüksek olduğunu ve yaşam boyu gelişme riskinin kadınlarda yüzde 47'ye ulaştığını göstermektedir. Hastalığın etyopatogenezinde yaş, cinsiyet, obezite, metabolik sendrom, ağır mesleki zorlanmalar ve geçirilmiş ön çapraz bağ ya da menisektomi ameliyatları gibi lokal ve sistemik multifaktöriyel risk faktörleri rol oynamaktadır. Moleküler düzeyde kıkırdak hasarı, matriks metalloproteinazlar (MMP-13) ve agrekanı parçalayan ADAMTS-5 enzimlerinin aşırı aktivitesi ile endojen inhibitörlerin (TIMS) yetersiz kalması sonucu tetiklenir. Klinik olarak mekanik karakterde diz ağrısı, kısa süreli sabah sertliği, hareket kısıtlılığı, krepitasyon ve ileri evrelerde genu varum gibi belirgin eklem deformiteleri ile fonksiyon kayıpları gözlenir. Tanısal süreçte Amerikan Romatizma Cemiyeti (ACR) klinik kriterleri ve Kellgren-Lawrence radyolojik sınıflama sistemi temel alınırken, erken evre yumuşak doku patolojilerini saptamada MRG tercih edilir. Tedavi yönetimi ise hastanın klinik durumuna göre egzersiz, kilo verme gibi non-farmakolojik uygulamalar, topikal ya da oral NSAİİ’ler ve ileri evrelerde artroplasti gibi cerrahi seçenekleri içeren kombine bir yaklaşımla yürütülür.
Knee osteoarthritis (KOA) is a prevalent low-grade chronic inflammatory joint disease characterized by the degradation of articular cartilage, osteophyte formation, subchondral sclerosis, and synovitis in weight-bearing joints. Global epidemiological data indicates that the prevalence of symptomatic knee osteoarthritis is significantly higher in women than in men, with the lifetime risk of development reaching approximately forty-seven percent in females. The disease has a multifactorial etiology involving both systemic and local risk factors, including advanced age, female gender, obesity, metabolic syndrome, heavy occupational workloads, and previous knee injuries or surgeries such as meniscectomy. At the molecular level, cartilage destruction is driven by the overactivation of matrix metalloproteinases, specifically MMP-13 and ADAMTS-5, which overwhelm protective endogenous tissue inhibitors. Clinically, patients present with mechanical knee pain, brief morning stiffness, limited range of motion, crepitus, and severe joint deformities like genu varum in advanced stages. Diagnosis relies on the American College of Rheumatology (ACR) criteria and the Kellgren-Lawrence radiographic grading system, while MRI is preferred for detecting early-stage changes. Management requires a combined approach encompassing non-pharmacological interventions like structured exercise and weight loss, pharmacological treatments such as topical or oral NSAIDs, and surgical options like arthroplasty for end-stage cases.
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