6: Osteoarthritis Flashcards
What is osteoarthritis?
Chronic slowly progressive disorder due to failure of articular cartilage that typically affecting joints of the hand (especially those involved in pinch grip), spine and weight-bearing joints (hips and knees)
–> non-autoimmune, non-inflammatory
What are the typically affected joints in osteoarthritis?
- Weight baring joints
- knee
- hip
- first metatarsalphalangeal joint
- Hands and fingers
- Distal interphalangeal joints (DIP)
- Proximal interphalangeal joints (PIP)
- First carpometacarpal joint (CMC)
- Spine
What are osteophytes?
Formation of bone spurs, commonly seen in oseoathritis
How do you call Osteophytes at the DIP joints?
Heberden’s nodes
How do you call Osteophytes at the PIP joints
Bouchard’s nodes
What are the signs and symptoms of osteoarthritis?
- Joint pain
- worse with activity, better with rest
- Joint crepitus
- creaking, cracking grinding sound on moving affected joint
- Joint instability –> due to muscular atrophy
- Joint enlargement
- e.g. Heberden’s nodes
- •Joint stiffness after immobility (‘gelling’)
- Limitation of motion
What are the radioglogical changes that can be seen in osteoarthritis?
- Joint space narrowing –> loss of cartilage
- Subchondral bony sclerosis (Dense area of bone just below the cartilage zone of a joint, formed due to a compressive load on the joint.)
- Osteophytes
- Subchondral cysts
Compare the radiological findings of Rheumtatic arthritis and Osteoarthritis
Explain the pathogenesis of osteoarthritis
A comnbination of abnormal stress on the joint and abnormal cartilage might lead to Cartilage loss due to
- chrondocyte apoptosis
- collagen fibril damage
- Loss of proteoglycans
What are the cartilogenous changes that occur in osteoarthritis?
- reduced proteoglycan (aggrecan main molecule)
- reduced collagen
- chondrocyte changes e.g. apoptosis
What are the bony changes in osteoarthritis?
- Changes in denuded sub-articular bone
-
sclerotic bone e.g. subchondral sclerosis
- proliferation of superficial osteoblasts
- Focal stress on sclerotic bone can result in focal superficial necrosis
-
sclerotic bone e.g. subchondral sclerosis
- new bone formation at the joint margins (termed osteophytes)
How would a swollen osteoathritic joint feel on examination?
It would feel hard –> ostefied + newly fomed bone
How do you manage osteoarthritis?
- Education–> often relatively benign and pain might resolve
- Physical therapy – physiotherapy, hydrotherapy Occupational therapy
- Weight loss where appropriate
- Exercise
- Analgesia
- •Paracetamol
- •Non-steroidal anti-inflammatory agents
- •Intra-articular corticosteroid injection
- Joint replacement (for lage joints, timing is important)!
Explain the role of Glucosamine and chondroitin sulphate in the management of osteoarthritis
Over the counter dietary supplements that are commonly taken
- contoversial, no evidence and not NICE recommended
