[37] Osteoarthritis Flashcards
What is the most common form of arthritis?
Osteoarthritis
What is osteoarthritis?
A degenerative joint disease, with the clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life
What joints does osteoarthritis most commonly affect?
- Knees
- Hips
- Small joints of hands
Pathologically, what does osteoarthritis acause?
- Gross cartilage loss
- Morphological damage to other joint tissues
- Biochemical changes
- Inflammation of the synovium and surrounding joint capsule
What happens pathologically during the onset of osteoarthritis?
The collagen matrix becomes more disorganised, and there is a decrease in proteoglycan content within cartilage
What is the result of the decrease in proteoglycan contact in early osteoarthritis?
Without the protective effect of proteoglycans, the fibers of the cartilage become susceptible to degradation, and thus exacerbate the degeneration
How does the degree of inflammation of the synvoium and surrounding joint capsule compare in osteoarthritis to rheumatoid arthritis?
It is mild in osteoarthritis compared to RA
What other structures within the joint can be affected in osteoarthritis?
The ligaments within the joint can become thickened and fibrotic, and the menisci can become damaged and wear away
What can form on the outer margins of joints in osteoarthritis?
New bony outgrowths, called osteophytes
What has the pain in an osteoarthritis joint been related to?
Thickened synovium and subchondrial bone lesions
What are the risk factors for the development of osteoarthritis?
- Joint injury, or overusing the joint when it hasn’t had enough time to heal after injury or operation
- Joints that are severely damaged by previous or existing conditions, such as rheumatoid arthritis or gout
- Age
- Family history
- Obesity
What are the signs and symptoms of localised osteoarthritis?
- Pain on movement, worse at end of day
- Crepitus
- Background pain at rest
- Joint felling (stiffness after rest) for up to 30 minutes
- Joint instability
What are the signs and symptoms of generalised osteoarthritis?
- Heberden’s nodes, commonly on DIP joints, thumb carpometacarpal joints, and knees
- Joint tenderness or derangement
- Bony swelling
- Decreased range of movements
When can a diagnosis of osteoarthritis be made on a clinical basis alone?
When the patient is;
- Age 45 or over
- Has activity related joint pain
- Has no morning joint stiffness, or joint stiffness that lasts for no longer than 30 minutes
What tests may be used in the diagnosis of osteoarthritis?
Further tests aren’t normally necessary, however blood tests and x-rays can be used to rule out other similar conditions
What is meant by a holistic approach to osteoarthritis assessment and management?
When someone is diagnosed with osteoarthritis, you should assess the effect on the person’s quality of life, occupation, mood, relationships, and leisure activity
What social factors should be assessed in the holistic approach to osteoarthritis management?
Effect on life, including ADLs, family duties, and hobbies
You should also look at lifestyle expectations
What occupational factors should be looked at in the holistic management of osteoarthritis?
Ability to perform job, both in the long term and short term, and any adjustments required to be made to the home or workplace
What mood factors should be assessed in the holistic management of osteoarthritis?
Screen for depression, and check for other current stresses in life
What should be assessed regarding the support network in the holistic management of osteoarthritis?
Nede to know the ideas, concerns, and expectations of the main carer, and how the carer is coping. Also need to know if the patient is isolated, and how to manage this if so
What should be assessed regarding other musculoskeletal pain in the holistic management of osteoarthritis?
Should find out if present, as this might suggest a chronic pain syndrome or another treatable source of pain
What should be assessed regarding the influence of co-morbidity in the holistic management of osteoarthritis?
The patient may have an interaction between two or more co-morbidities. This might affect the fitness for surgery, or ability to understand surgical options. It might also alter the assessment of the most appropriate drug therapy, or increase the risk of falls
What education should a patient with osteoarthritis be given?
About the condition and it’s management.
Should dispel common misconceptions, such as that the disease inevitably progresses and cannot be treated/
What might be included in an individualised self-management plan for patients with osteoarthritis?
- Positive behaviour changes
- Weight loss
- Use of suitable footwear
In whom is exercise a core treatment in osteoarthritis?
Everyone, irrespective of age, comorbidity, pain severity, or disability
What should exercise include in the management of osteoarthritis?
Local muscle stregthening and general aerobic fitness
Who should be offered interventions to achieve weight loss in osteoarthritis?
Those who are obese or overweight
What aids and devices can be used in the management of osteoarthritis?
- Appropriate footwear
- Bracing/joint supports
- Assistive devices such as walking sticks and tap turners
What is the role of transcutaneous electrical nerve stimulation (TENS) in osteoarthritis?
It should be considered as an adjunt to core treatments in pain relief
What is the first line analgesia in osteoarthritis?
Paracetamol and topical NSAIDs
What is used if paracetamol and topical NSAIDs are ineffective in the treatment of osteoarthritis?
Consider opioid analgesics, taking into account risks and benefits, particularly in the elderly
Oral NSAIDs or COX-2 inhibitors can be considered
What should be done when giving oral NSAIDs or COX-2 inhibitors in osteoarthritis?
You should give at lowest possible dose, for shortest period of time.
You should co-prescribe a PPI
What is the role of intra-articular corticosteroid injections in the treatment of osteoarthritis?
They can be considered as an adjunct to other analgesia in the relief of moderate to severe pain with osteoarthritis
When might surgery be considered in osteoarthritis?
In people who are experiencing joint symptoms, including pain, stiffness, and reduced function, that has a substantial impact on their quality of life, and are not responding to non-surgical treatment
What factors should not be a barrier to referral for joint surgery
Patient specific factors, such as;
- Age
- Sex
- Smoking
- Obesity
- Co-morbidities
What should be discussed when considering the possibility of joint surgery in osteoarthritis?
- Benefits and risks of surgery
- Consequences of not having surgery
- Recovery and rehabilitation after surgery
- How having a prosthesis may affect them
What are the surgical options in osteoarthritis?
- Arthroplasty
- Artherodesis
- Osteotomy
What is arthroplasty?
Joint replacement therapy
What joints is arthroplasty most commonly carried out on?
The hip and knee joints
What happens during an arthroplasty?
The affected joint is removed and replaced with a prosthesis made out of plastic and metal
How long can a joint replacement last for?
Up to 20 years
What is arthrodesis?
Where the joint is fused together in a pernament position, making the joint stronger and much less painful, but no longer mobile
When is arthrodesis used?
When joint replacement isn’t suitable
What does an osteotomy involve?
Adding a small section of bone either above or below the knee joint
What is the purpose of an osteotomy?
It helps realign the knee, so that the body weight is no longer focused on the damaged part of the knee, providing symptomatic relief
When is an osteotomy used in the management of osteoarthritis?
When the patient has osteoarthritis in the knees, but isn’t suitable for a knee replacement
