Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

“wear and tear” of joints
not an inflammatory condition like RA

occurs in the synovial joints due to genetic / over use / injury. an imbalance between cartilage being worn down and chondrocytes repairing leading to structural issues in the joint.

Question 2

what are risk factors for osteoarthritis?

Answer 2

obesity, age, occupation, trauma, female, fhx

Question 3

what abnormalities would you see on Xray?

Answer 3

LOSS

Loss of joint space
Osteophytes
Subchondral / subarticular sclerosis (increased density of the bone along the joint line)
Subchondral cyst (fluid filled holes in bone- geodes)

symptoms and X-ray changes do not always correlate

Question 4

symptoms of osteoarthritis

Answer 4

pain and stiffness in joints
worsened by activity
(inflammatory arthritis improves with activity)

deformity
instability
reduced function of the joint

Question 5

which joints are commonly affected in OA?

Answer 5

Hips
Knees
Sacro-iliac joints
Distal-interphalangeal joints in the hands (DIPs)
The MCP joint at the base of the thumb
Wrist
Cervical spine

Question 6

OA in HANDS

Answer 6

“nodes”

Haberden's nodes (DIP)
Bouchards nodes (PIP)
b= below
Squaring of the base of thumb (carbo-metacarpal joint)

Question 7

how is osteoarthritis diagnosed?

Answer 7

1. conservative:
   patient education
   lifestyle changes: weight loss, physiotherapy to improve with strength and support the joint, occupational therapy, orthotics to support activities and function

2. medical
analgesia (stepwise)
paracetemol 
topical NSAIDS
topical capsaicn
\+ PPI (omeprazole / ranitidine)
opiates- codeine, morphine (educate about side effects and dependence / withdraw)

3. surgical:
   IA steroid injections (temp)
   joint replacement (severe- hip and knee)