OA Flashcards
OA and CV mortality?
x3 increased CV mortality
x2 all cause mortality
With radiographic knee OA. Higher risk if symptomatic.
Warfarin and OA?
Higher risk of OA in the knee and higher risk of needing knee replacement
If there is a choice, use NOAC
Risk factors for OA
Most important is Age
Before 50, men>women, after 50, women>men (post menopause)
Obesity/overweight
Lack of OP
Vitamin K analogues
Genetics
Previous injury
Lack of exercise (muscles protect joints) but high impact sports/injuries/meniscectomy can increase OA
Genetics in OA
Yes
But no single gene. Its multiple genes.
Young men with OA
What to look for?
Dysplasia of the hip
Haemachromatosis
Radiographic OA
Are they all symptomatic?
Not all symptomatic
Women get more symptomatic than men
Risk factors for developing symptoms + disability
- More advanced radiographic findings
- Female
- Lower education
- Obesity
- Poor muscle strength
OA symptoms
Pain Loss of function Morning stiffness, brief Swelling Deformity
OA radiological features
Loss of joint space
Subchondral cysts and sclerosis
Osteophyte
OA of the hands
Which joints?
Spares MCP
Affects DIP and PIP
OA treatment
Classify whether its knee only or multiple joint OA
Classify no, moderate or high comorbidity
Exercise - low impact exercise like swimming, walking, cycling. No jogging. Balance training Weight loss Cane knee brace or hand orthoses Heat, therapeutic cooling CBT Acupuncture
NSAIDs oral NSAIDs topical IA steroids Paracetamol Tramadol Duloxetine Topical capsaicin for knee, not hip
Opioids for OA
Avoid!
Bisphosphonates for OA
Some data to show that zoledronic acid can reduce knee pain and BM lesion at 12 months
But not really used much for that
Duloxetine for OA
Reduces pain
Can be helpful in those failing NSAIDs
Chondroitin and glucosamine for OA
No evidence
Intra-articular steroids for OA
No better than saline injection
Has mild placebo effect only
Can increase joint damage/cartilage loss
