6.7. Rheumatology - Osteoarthritis Flashcards
What is the commonest form of Joint problems?
Osteoarthritis
It affects 50% of the population > 60 years old
What is Osteoarthritis defined as?
Note - This is by Arthritis Research UK
“Tear, Flare and Repair”
- Tear - Trauma and Mechanical Imbalance
- Flare - Inflammation and Pain
- Repair - Repair Process around the Joint
What are the Biomechanical Factors which can affect Osteoarthritis?
- Abnormal Anatomy - Developmental Dislocation of the Hip (DDH)
- Intra-Articular Fracture
- Ligament Rupture
- Meniscal Injury
- Occupation - Farmers
- Persistent Heavy Physical Activity
- Obesity
What are the Inflammatory Factors which are part of Osteoarthritis?
- Synovial Hypertrophy
- Subchondral Changes
- Joint Effusion
What is the pathogenesis of Osteoarthritis?
- Muscle Weakness / Ligament Injury / Abnormal Anatomy lead to Instability / Malalignment
- Obesity + Instability / Malalignment leads to an increase load on the Joints
- An increase load on the Joint can lead to Joint Microtrauma and an Osteoarthritic Joint and Synovitis
What Biochemical Mediators become elevated as a result of Osteoarthritis?
- IL-1 Beta
- TNF-Alpha
- MMPs
How is Osteoarthritis diagnosed, from a History?
- > 45 years old
2. Activity related Joint pain + morning stiffness which lasts less than 30 minutes (if any)
What symptoms are indicative of the diagnosis not being Osteoarthritis?
- Trauma
- Prolonged morning-related stiffness
- Rapid deterioration of Symptoms
- Hot, Swollen Joint
What is the Differential Diagnosis for Osteoarthritis?
- Gout
- Other inflammatory Arthritides
- Septic Arthritis
- Malignancy
Where can Osteoarthritis be managed?
- Primary Care
2. Secondary Care
What management strategies and options are available for Osteoarthritis?
Note - These are from the NICE Guidlines
- Person Diagnosed with Osteoarthritis
- Holistic Approach and Self-Management
- Core Treatments: Information, Exercise, and Weight Loss
- Additional Treatment Options:
- a) Non-Pharmacological Treatments
- b) Pharmagological Treatments
- c) Referral for Consideration of Joint Surgery
What are the Aspects of the Holistic Assessment of a Person with Osteoarthritis?
- Social
- Health Beliefs
- Occupational
- Mood
- Quality of Sleep
- Support Network
- Other Musculoskeletal Pain
- Attitudes to Exercise
- Influence of Comorbidity
- Pain Assessment
What are the Non-Pharamcological treatments of Osteoarthritis?
- Thermotherapy
- Electrotherapy
- Aids and Devices
- Manual Therapy
What are the Pharmacological treatments of Osteoarthritis?
- Oral Analgesia (Paracetamol, NSAID’s)
- Topical Treatments:
- a) NSAID’s
- b) Capsaicin (Knee, Hand)
When is referral to Surgery indicated in Osteoarthritis?
- Substantial impact on Quality of Life
- Refractory to Non-Surgical Treatment
- Referral Letter
