Arthritis

Question 1

Osteoarthritis: signs on XR

Answer 1

LOSS

• Loss of joint space
• Osteophytes
• Subchondral cysts
• Subchondral sclerosis

Question 2

OA.

a) Pathogenesis
b) Risk factors
c) Presentation - general
- knee OA
- hip OA
d) Investigations

Answer 2

a) Degenerative ‘wear and tear’ process in the joints, leading to loss of cartilage and bone remodelling
b) Age, female, FHx, obesity, occupational/mechanical stress, biomechanical (joint malalignment, joint instability/laxity, joint injury)

c) - General: joint pain and stiffness, generally worse with activity; rest and night pain in advance OA
- Knee: usually bilateral pain, felt in and around the knee.
- Hip: pain felt in the groin and anterior or lateral thigh (more posterior pain is usually from the back)

d) - XR affected joints - LOSS
- FBC and U+Es before starting NSAIDs
- ?inflammatory cause - CRP, RhF, anti-CCP, joint aspirate.

Question 3

OA: diagnostic criteria

- 3 criteria to diagnose clinically

Answer 3

• Aged 45+, and
• Activity-related joint pain; and
• No morning stiffness or morning stiffness < 30 minutes

Question 4

OA: signs on examination

a) Inspection
b) Palpation
c) Movement
d) 1st movement to be lost at the hip

Answer 4

a) - Bony swelling and deformity due to osteophytes, eg:
- Heberden’s nodes at the DIPJs;
- Bouchard’s nodes at PIPJs
- Squaring of the thumb (1st CMCJ)

b) - Periarticular tenderness.

c) - Reduced range of joint movement.
- Pain on movement of the joint or at extremes of joint movement.
- Crepitus.

d) Internal rotation?

Question 5

OA: management.

a) Non-drug
b) Drug
c) Surgical - when is it indicated?

Answer 5

a) - Patient education - manage expectations, encourage self-management
- Lifestyle: weight loss, exercise
- Allied HCPs - PT, OT, orthotics, psychological
- Devices: thick-soled shoes, braces, walking aids, OT devices (tap turners, stairlifts, etc.)

b) Analgesic pain ladder:
- 1st line - paracetamol + topical NSAID
- 2nd line - oral NSAID (+ PPI)
- 3rd line - weak opioid (eg. tramadol)
- Adjuvant: intra-articular steroid injections

c) - Failure of conservative management
- Severe pain impacting on QoL
- Severe functional limitation