A3- The Diagnosis and Management of Osteoarthritis Flashcards
WHat do we call non inflammatory arthritis
osteoarthritis
Give some examples of inflammatory arthritis?
- Tophaceous gout
- Spondyloarthropathy – Psoriatic arthritis – Reactive arthritis – Ankylosing spondylitis – IBD related arthropathy
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Infection – Lyme
WHat are the main symptoms of osteoarthritis?
Typical distribution of joints affected (hips, knees, back, neck, hands)
Pain & stiffness worse on initiating movement and towards the end of the day
Often worse with increased activity
Gradual onset
WHat are the main symptoms of Inflammatory – e.g. rheumatoid arthritis?
Significant early morning pain and stiffness (>30mins)
Improves with activity
Often symmetrical distribution
Acute onse
What are some red flag symptoms (thinking of cancer)
Unremitting pain
Systemic upset
Significant past medical history (e.g. systemic steroids, cancer)
What are the 5 rules for musculoskeletal examination
- Always examine the patient
- Expose the area you are examining - Look for redness, rashes, swelling or deformity of the affected area
- Use the look, feel, move approach. ROM (active, passive and resisted movement)
- Compare findings with the other side
- Screen the joint above and joint below
GALS
• Gait, • Arms, • Legs and • Spine
What are the physical examination findings for osteoarthritis
- Vital signs - Usually normal
- Gait - Often antalgic with lower extremity joint involvement
- Joints - Joint effusions may be present
- Bony swelling may be observed due to osteophyte formation.
- Joints rarely warm to touch. Normal joints are cooler than the area over normal muscle bellies.
- Joint range of motion may be limited, with pain at the endpoints of motion. On hip examination, internal rotation will often elicit pain when hip OA is present
- Joint lines may be tender to palpation
- Joint crepitations may be present
- Ligament stability is usually unaffected in early disease but may occur in late disease.
What are the four signs on radiograph of osteoarthritis
- joint space narrowing
- osteophytes
- joint line sclerosis
- subchondral cysts
What are some nonpharacologic therapy for OA
- Weight loss and activity modification can reduce stress across lower extremity joints.
- Physical therapy strengthens the musculature that supports the affected joint
. • Braces may assist in off-loading affected joints (e.g., unloader brace for knee OA)
Name some pharmacologic therpay for OA
- Paracetamol.
- Nonsteroidal antiinflammatory drugs (NSAIDs)
- Topical diclofenac
- Oral corticosteroids should be avoided in osteoarthritis
- Intra-articular injections often rapidly reduce pain but have been shown to lead to accelerated thinning of cartilage.
- Intra-articular viscosupplementation with hyaluronic acid derivatives has been shown to reduce symptoms in mild to moderate arthritis and does not appear to contribute to progression of cartilage loss.
Surgery options for OA
• Debridement • Osteotomy • Arthroplasty • Arthrodesis
What is debridement
