Osteoarthiritis

Question 1

What is OA?

Answer 1

• Commonest type of arthirits
• Degenerative joint disorder which there is progressive loss of articular cartilage
• Accompanied by new bone formation and capsular fibrosis

Question 2

Aetiology of OA - 3 causes

Answer 2

1. Failure of normal cartilage subject to abnormal or unsuitable loading for long periods of time
2. Damaged or defective cartilage failing under normal conditions or loading
3. Break up of cartilage due to defective stiffened subchondral bone passing more load onto it

Question 4

Key features of cartilage in OA

Answer 4

• Loss elasticity with reduced tensile strength
• Cellularity and proteoglycan content are reduced

Question 5

RF for OA

Answer 5

• Increased age - age 65 80% have radiographical features
• Women more symptomatic
• Obesity - incidence and progression affected
• Trauma and joint misalignment (via trauma or muscle weakness)
• Genetic studies - knee OA

Question 6

Which joints most commonly affected?

Answer 6

• Hip
• Knee
• Spine

Question 7

Symptoms

Answer 7

• Pain provoked by movement and weight bearing
• First intermittent then constant
• At knee, inactive gelling (finding hard to move joint) and give way sensation is common

Question 8

OA features on x-ray

Answer 8

• Loss joint space
• Osteophytes
• Subarticular sclerosis
• Subchondral cysts

Question 9

Treatment aims

Answer 9

• Improve pain
• Reduce disability

Question 10

Non-drug therapy OA

Answer 10

• Should be offered to all
• Strengthening and range of exercises - esp for knee/hip
• Reduce loading of joint - weight loss, laterally wedged insoles, walking stick

Question 11

Pharmacological therapy OA

Answer 11

• Paracetamol 1st choice
• NSAIDs short term
• Topical NSAIDs and topical rubefacients (eg deep heat) and capsaicin (chilli pepper extract)
• Intrarticular steroid

Not good evidence for glucosamine or chondroitin sulphate

Question 12

Surgical management

Answer 12

• If combined pharmacological and physical management failed
• Surgery can be considered
• Joint replacement - hip is most successful
• Younger patients have higher chance of revision surgery

Question 13

Where can pain in OA come drom?

Answer 13

• Any tissue apart from cartilage which is avascular and aneural
• Can be subchondral bone, low grade synovitis, capsular distension or muscle spasm

Question 14

OA symptom severity and x-ray severity

Answer 14

NOT RELATED

Question 15

What is OA of the hands closely related to?

Answer 15

OA of knees - strong associatation

Question 16

Who is nodal (hand) OA common in and what does it affect?

Answer 16

• Women
• PIPJ (Bouchards nodes)
• DIPJ (Herbeden’s nodes)
• And thumb