Orthopaedics - osteoarthritis

Question 1

Risk factors for OA

Answer 1

Obesity
Age
Occupation
Trauma
Female
Family history

Question 2

Four key X-ray changes

Answer 2

LOSS

L – Loss of joint space
O – Osteophytes (bone spurs)
S – Subarticular sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone)

Question 3

Presentation of OA

Answer 3

Joint pain and stiffness

Worse with activity and at the end of the day

Signs:

• Bulky, bony enlargement of the joint
• Restricted range of motion
• Crepitus on movement
• Effusions (fluid) around the joint

Question 4

OA signs in the hands

Answer 4

Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb at the carpometacarpal joint
Weak grip
Reduced range of motion

Question 5

Management of OA

Answer 5

Weight loss (if overweight, to reduce load on the joint)

Physiotherapy to improve strength/function

Analgesia in a stepwise approach WHO ladder
- Consider co-prescribing PPI with NSAIDs

Topical capsaicin

Intra-articular steroid injections

Joint replacements - typically the hip and knee
- Usually considered only when mobility reduced or pain at rest or pain uncontrolled by analgesia and impacting life

Question 6

Side effects of NSAIDs

Answer 6

Gastrointestinal side-effects, such as gastritis and peptic ulcers (leading to upper GI bleeding)

Renal side-effects, such as acute kidney injury (e.g., acute tubular necrosis) or progressive kidney disease

Cardiovascular side-effects, such as hypertension, heart failure, myocardial infarction and stroke

Exacerbating asthma

• Best used for a short period in order to gain control of pain rather than continuously