Monoarticular Joint Pain: Osteoarthritis of peripheral joints

Question 1

What is OA?

Answer 1

OA is a disease of the entire joint
- Cartilage, Synovium, Ligaments, and Bone
- Breakdown of these tissues (lining of joint) → PAIN and JOINT STIFFNESS
- Knees, Hips, Hands most commonly affected

Question 2

What causes OA?

Answer 2

• Specific causes unknown:
  
  • Biological factors
  • Mechanical factors

Onset is gradual, usually > 40 years old.

Question 3

What treatment does OA include?

Answer 3

Treatment focuses on relieving symptoms and improving function:

• Patient education,
• Exercise
• Weight control
• Use of analgesia / orthosis (splint)
• Surgery

Question 4

What happens in OA with regard to acc bone?

Answer 4

no articular cartilage, bone loss, inflammation and thickening of synovium and capsule

Question 5

Causes of OA?

Answer 5

• Secondary
  
  • Trauma
  • infection
  • Inflammatory
  • Rheumatoid arthritis
  • Perthes’ disease
  • Slipped upper femoral epiphysis

Question 6

What is mainly seen in OA of hips?

Answer 6

• walking aid may be used
• femoral head has loss of articular cartilage and have osteocytes

Question 7

What is mainly seen in oa of knees?

Answer 7

• knee valgus = away from midline?
• OA affects more of weight bearing side - affects more medial side and slightly more weight bearing

Question 8

What is seen in OA of hands?

Answer 8

OA of hands/fingers:
- Heberden’s nodes → osteocyte sweeling of joint - distal phalynx
- OA in base of thumb → constant loss of joint space - squaring/lumpy base of thumb
- thumbs:
- Key Pinch
- Tip Pinch
- Tripod Pinch
- (Composite first or grip)

Question 9

What is Arthrodesis?

Answer 9

Fusion of bones

Question 10

What is Arthroplasty?

Answer 10

• Arthroplasty (replacement) → new joint, some fibrious tissue reaction and some movement
  
  • Excision arthroplasty
  • Hemi arthroplasty → half a hip
  • Total joint arthroplasty

Question 11

What are complications with Arthroplasty?

Answer 11

• Immediate:
• • Technical eg. perioperative fracture
    
    • Early:
      
      • Infection
      • Dislocation – constrained or unconstrained?
    • Late:
      
      • Aseptic loosening (bone implant interface)
        
        • Wear
        • (bearing…..’ASR metal on metal hip replacement’)

Question 12

What is a PIP and what does it allow?

Answer 12

PIP joint allows for mobility → often needed to be replaced.

• give pain relfied
• keep movemnt rather than fusing → but may not be durable → can wear out

Question 13

Fuse vs replace? - apply to wrist

Answer 13

• go bone acorss the wrist - pain relief and stabel wrist for heavy lifting but not a lot of movement
• joint replacment → pain releif and movement but can cause losening

Question 14

What happens in OA of wrist?

Answer 14

Elbow OA - rare:

• Inflammatory
• Rheumatoid
• Pain flexion/extension
• Pain pronation/supination

Question 15

What is asked to pt with OA?

Answer 15

History:

What is the presenting complaint?

Site of pain

Onset of pain

Functional problems

Walking distance, stairs (hips & knees)

Using a key, opening jar tops (hands)

Treatments tried

(Rest of standard history)

Question 16

What are the NICE guildelines for OA?

Answer 16

Diagnose osteoarthritis clinically without investigations if:

45y or over

Activity-related joint pain

Either no morning joint-related stiffness

Or morning stiffness that lasts no longer than 30 minutes

Offer advice on:

Activity and exercise,

Interventions to lose weight if the person is overweight or obese

In addition consider offering :

Paracetamol for pain relief

Paracetamol and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) should be considered ahead of oral NSAIDs

Cyclo-oxygenase (COX-2) inhibitors or opioids

Refer for consideration of joint replacement surgery:

Before there is prolonged and established functional limitation and severe pain

patient-specific factors (including age, sex, smoking, obesity) should not be barriers to referral for joint surgery

Offer regular reviews to all people with symptomatic osteoarthritis:

Monitoring the long-term course of the condition

Reviewing the effectiveness and tolerability of treatments and other points

Annual reviews should be considered if the person has one or more of:

Other illnesses or conditions

Troublesome joint pain, more than one joint affected

Or are taking any drugs for their osteoarthritis

Painful joints in patients > 50 yrs old are usually due to osteoarthritis

How to manage OA depends on the patient

What can’t they do?

What do they want to do?

Are they motivated to get better?

Ideas Concerns Expectations