OSTEOARTHRITIS Flashcards
What is osteoarthritis?
-a non-inflammatory degenerative disorder of synovial joints, characterised by progressive destruction and loss of articular cartilage with an accompanying bone response
What is the most common condition affecting synovial joints?
osteoarthritis
Describe the pathophysiology of OA
- Articular cartilage most affected
- Changes in underlying bone at the joint margins–>exposed subchondral bone becomes sclerotic, with increased vascularity and cyst formation
- Metabolically active and dynamic process-mediated by cytokines(IL-1, TNF-alpha, NO)
- Driven by mechanical forces
What are the main pathological features of OA?
- Loss of cartilage
- Disordered bone repair (attempts at repair produce cartilaginous growths at the margins of the joint which become calcified - osteophytes)
Describe OA of Hands
-affects DIP, PIP, Carpal Metacarpal joints
-relapsing , remitting course over a few years
-‘Nodal’ form has a strong genetic component
-Bony swelling and cyst formation–>
Heberden’s nodes (DIP)
Bouchard’s nodes (PIP)
Describe OA of Knee
-most commonly affects medial knee
-can also affect lateral &
patellofemoral
-Without significant trauma, evolution very slow
-Once established, often remains stable for years
Describe Erosive / Inflammatory OA
- Subset of OA
- Strong inflammatory component
- In addition to standard management, DMARD therapy (usually milder agents) often used
Describe Loose Body in Knee
- Associated with locking of the knee
- Bone or cartilage fragment
- Only indication for arthroscopy in OA
What are the risk factors for OA?
- Age
- Gender-More common in females
- Genetic Predisposition
- Obesity
- Occupation-manual labour
- RA
- Trauma
- Abnormal biomechanics- joint hypermobility
What are the signs of OA?
- Alteration in gait
- Joint Swelling; bony enlargement, effusion, synovitis
- limited Range of Movement
- Deformities
- Crepitus (popping, crackling and grating sounds)
- Locking of knee (loose bodies)
- Bony swelling (Heberden’s at DIP, Bouchard’s at PIP)
What are the symptoms of OA?
Pain
- Often reason patient seeks medical advice
- May not be present despite significant changes on x ray
Functional Impairment
- Walking
- Activities of daily living
- Worsens with prolonged activity (differs from RA), relief with rest
Tenderness
What are the investigations for OA?
X-RAY which shows; L - loss of joint space O - osteophyte formation S - subchondral sclerosis S - subchondral cysts -Abnormalities - bone contour
Also
- FBC - CRP might be slightly elevated, but should be mostly normal.
- MRI - demonstrates early cartilage changes (not necessary for most patient with typical plain x ray features)
What is the non-pharmacological treatment for OA?
- Patient education
- Activity and exercise
- Weight loss
- Physiotherapy
- Occupational therapy (esp for hand)
- Footwear
- Orthoses
- Hot and cold packs at site of pain (thermotherapy)
- Walking aids on contralateral side
What is the pharmacological treatment for OA?
- Topical NSAIDs and Capsaicin
- Oral Paracetamol/Opioids
- Transdermal Patches (last resort); Buprenorphine/Lignocaine
- Intra-articular steroid injections (good for knee, but not long term)
- Intra-articular hyaluronic acid injection (more for lubrication)
- DMARDs (for inflammatory OA)
What is the surgical treatment for OA?
- Arthroscopy (only for loose bodies)
- Osteotomy
- Arthroplasty
- Fusion, Usually ankle and foot->end up with much less movement
