Osteoarthritis

Question 1

What is osteoarthristis?

Answer 1

Wear and tear of joints

Not inflammatory

Question 2

Where is osteoarthritis generally?

Answer 2

Synovial joints

Question 3

What joints does osteoarthritis affect?

Answer 3

• Hips
• DIPs
• MCPs at base of thumb
• Knees
• Wrist
• Cervical spine
• Sacro-iliac joints

Question 4

Why does osteoarthritis occur?

Answer 4

Imbalance between cartilage being worn down and chondrocytes repairing it leading to structural issues in the joint

Question 5

Who would be likely to get osteoarthritis?

Answer 5

• Females
• Fam History
• Obese people
• Older age
• Injured/trauma
• Occupational hazard

Question 6

Presentation of osteoarthritis?

Answer 6

-Joint pain & stiffness (especially worsened by activity)

Question 7

Signs of osteoarthritis?

Answer 7

Heberden's nodes (DIP)
Bouchard's nodes (PIP) 
Squaring at base of thumb at carpo-metacarpal joint 
Weak grip 
Reduced range of motion

Question 8

Investigation for osteoarthritis?

Answer 8

X-ray but not always necessary

Question 9

X-ray changes for osteoarthritis?

Answer 9

L- Loss of joint space
O- Osteophytes
S- Subarticular sclerosis
S- Subchondral cysts

Question 10

What is subarticular sclerosis?

Answer 10

Increased density of bone along joint line

Question 11

Diagnostic criteria for osteoarthritis?

Answer 11

> 45 years old
Activity related pain & stiffness
No morning stiffness/stiffness lasting <30 minutes

Question 12

Management of osteoarthritis?

Answer 12

Education: Weight loss

• Stepwise use of analgesia
• Intra-articular steroid injections
• Joint replacement

Question 13

Stepwise use of analgesia?

Answer 13

1. Oral paracetamol & topical NSAIDs or topical capsaicin
2. • oral NSAIDs & consider PPI to protect stomach
3. Consider opiates (morphine or codeine)