Osteoarthiritis Flashcards
What is osteoarthiritis
progressive synovial joint damage resulting in structural changes, pain and reduced function. It is the ‘wear and tear’ of joints.
Classical X RAY findings of osteoarthritis
L- loss of joint space
O- Osteophytes formation
S- Subchondral sclerosis
S- Subchondral cysts
What is the most common form of arthiritis
Osteoarthirits
Risk Factors for osteoarthirits
- Age
- Female sex
- Raised BMI
- Joint injury or trauma
- Joint malalignment and congenital joint dysplasia
- Genetic factors (COL2A1 collagen type 2 gene) and family history
Is osteoarthritis inflammatory or non- inflammatory
NON INFLAMMATORY
Pathophysiology of OA
As cartilage is lost through wear and tear , the joint space narrows, with areas of highest load affected the most.
Bone on bone interaction may occur causing large amounts of stress and reactive changes with subchondral sclerosis
Basic summary of OA
Essentially, cartillage is lost and chondroblasts are unable to replace and repair the lost cartillage, this leads to abnormal bone repair.
Mechanisms of OA
- Metalloproteinases secreted by chondrocytes degrade the collagen and proteoglycan
- Interleukin 1 (IL-1) and tumour necrosis factor-alpha (TNF-alpha) stimulate metalloproteinase production and inhibit collagen production
- Deficiency of growth factors such as insulin-like growth factor and transforming growth factor impairs matrix repair
Most affected areas in OA
Knees
Hip
Sacro-iliac joint
Wrist
Signs of OA
- Heberden’s nodes: swelling in distal interphalangeal joint (top finger joint)
- Bouchard’s nodes: swelling in proximal interphalangeal joint (middle finger joint)
- Fixed flexion deformity of carpometacarpal (base of thumb)
- Mucoid cysts: painful cyts found on dorsum of finger
Symptoms of OA
- Joint pain which is worse with activity
- Mechanical locking
- Giving way
- Joint tenderness
- Joint effusion (fluid in or around joint)
- Limited joint movement - stiffness
Investigations for OA
Investigations not always needed if there is a typical presentation:
- Over 45 years of age
- Typical activity related pain
- No morning stiffness (or morning stiffness <30 minutes)
What is 1st line imaging
X-RAY
Non - pharmacological management
-Patient education
-W/L
-Physio
-Hot or cold ice packs
Pharmacological management of OA
- 1st line** - oral paracetamol + topical NSAIDs + topical capsaicin
- Oral NSAIDs + proton pump inhibitos (to protect the stomach from NSAID use)
- CONSIDER OPIATES such as codeine and morphine - use with caution
