Locomotor Conditions Flashcards
What is osteoarthritis
A degenerative disorder, prevalence increases with age.
Most commonly affected joints are the knee, hip, hands and lumbar and cervical spine
The result of mechanical and biological events that destabilise the normal process of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix and subchondral bone.
It involves the entire joint, including the articular cartilage, subchondral bone, pericapsular muscles, capsule and synovium.
The condition leads to loss of cartilage, sclerosis and eburnation of the subchondral bone, osteophytes and subchondral cysts.
It is clinically characterised by join pain, stiffness and functional limitation
Who does osteoarthritis affect
Western populations
Over 50s
Women more commonly
What causes osteoarthritis
A host of biological and mechanical factors that culminate in development of OA
Age
Hereditary predisposition
Femaile sex
Obesity
Articular congenital deformities or trauma to the joint
High bone mineral density and low oestrogen status (post-menopausal)
What are the risk factors for osteoarthritis
Age >50 Female Obesity Genetic factors Knee malalaignment Physically demanding occupation/sport High bone mineral density
How does osteoarthritis present
Presents with joint pain and stiffness that is typically worse with activity
Pain associated with activities, with pain in weight-bearing joints being associated with weight-bearing activities
Pain at rest or at night in unusual, except in advanced OA
Functional difficulties, such as knee giving way or locking, reflecting internal derangement such as a partial meniscal tear or a loose body within the joint
Knee, hip, hand or spin involvement
Hand OA spares metacarpophalangeal (MCP) joints and involves the proximal interphalangeal and distal interphalangeal joints (PIP and DIP), which helps distinguish from RA
Bony deformities:
-Common in hands
-Enlargment of PIP joints (Bouchard’s nodes)
-Enlargement of DIP joints (Heperden’s nodes)
-Squaring of base of the thumb
-Advance knee OA may have bony swellings around the knee joint
Limited range of motion
Malalignment
Tenderness
Crepitus
Stiffness
Effusion in the join cavity
Antalgic gait (limp)
Radiographs show loss of joint space, subchondral sclerosis and osteophytes
What other conditions present similarly to osteoarthritis
Bursitis Gout Pseudogout Rheumatoid arthritis Psoriatic arthritis Avascular necrosis Internal derangements (eg meniscal tears)
How is osteoarthritis investigated
Xray of affected joints:
-Can detect moderate to advanced OA but not sensitive in early disease
-New bone formation (osteophytes)
-Joint space narrowing
-Subchondral sclerosis
-Cysts
Serum CRP
Serum erthrocyte sedimentation rate (ESR)
Rheumatoid factor
Anti-cyclic citrullinated peptide (anti-CCP) antibody
MRI of affected joints
What are important discussions to have with patients with osteoarthritis
Consult physician if they have persistent pain in joints on most days for more than 1 months
A combination of exercise, physio, healthy lifestyle, and medications are most appropriated
Refer the patient to a rheumatologist and/or orthopaedic specialist if they have significant pain or limitation in their activites
What is the treatment for osteoarthritis
Goal is to controll join pain and stiffness to improve function Physiotherapy and occupational therapy Self-management Education Weight-loss Topical analgesics are first line Oral analgesics: -paracetamol -NSAIDs -Opioids -Duloxetine (SNRI) Intra-articular corticosteroid injections Joint replacement surgery
What is gout
A syndrome characterised by hyperuricaemia and deposition of urate crystals causing:
- attacks of acute inflammatory arthris
- tophi around the joints
- possible joint destruction
- renal glomerular, tubular and interstitial disease
- uric acid urolithiasis
Most commonly affects the first toe, foot, ankle, knee, fingers, wrist, and elbow but can affect any joint
How common is gout
Incidence of gout per 1000 person per year in UK is 2.68 (4.42 in men and 1.32 in women) and increases with age
Who gets gout
In western countries, gout occurs in 3% to 6% of men and 1% to 2% of women
Prevalence varies geographically and racially, being highest in Pacific countries
Rare in pre-menopausal women
What causes gout
A causal relationship between hyperuricaemia and gout
What are the risk factors for gout
Strong: Older age Male Menopausal Consumption of meat, seafood and alcohol Use of diuretics Use of cicloporin or tacrolimus Use of pyrazinamide Use of aspirin Genetic susceptibility High cell turnover rate
Weak: Obesity Adiposity and insulin resistance Exogenous insulin Hypertension Renal insufficiency Diabetes Hyperlipidaemia Family history of gout
How does gout present
Rapid onset pain Joint stiffness Foot joint distribution Few affected joints Swelling and joint effusion Tenderness Tophi Erythema and warmth
Which other conditions may present similarly to gout
Pseudogout Septic arthritis Trauma Rheumatoid arthritis Reactive arthritis Psoriatic arthritis
How would a patient with gout be investigated
Arthrocentesis with synovial fluid analysis Serum uric acid level Ultrasound Dual energy computed tomography (DECT) Xray of affected joint
What are the important patient discussions to have about gout
Advise that foods with high purine (alcohol, seafood and offal) are associated with higher risk of elevated uric acid and gout
Reducing intake of alcohol, lowers the risk of gout
Reducing seafood and meat intake helps to a lesser degree
Reducing fructose and concetrated sweets might help to reduce uric acid and risk of gout attacks
Dair products reduce the risk of gout
