Osteoarthritis Flashcards
1
Q
ESSENCE
A
Described as ‘wear and tear’ of joints
Not inflammatory condition like RA
2
Q
AETIOLOGY
Risk factors
A
- Age > 50
- Female sex
- Obesity
- Genetics
- Knee malignment
- Physical demanding occupation/sport
3
Q
AETIOLOGY
Pathophysiology
A
- Imbalance between cartilage breakdown and the chondrocytes repairing it, leading to structural issues in joints
4
Q
What kind of joints are affected
A
Synovial joints
5
Q
Commonly affected joints
A
- Hips
- Knees
- Sacro-iliac
- Distal interphalangeal joints (DIPs)
- Carpometacarpal joint base of thumb (CMC)
- Wrist
- Cervical spin (cervical spondylosis)
6
Q
4 key x-ray changes
A
- Remember LOSS
- Loss of joint space
- Osteophytes (bone spurs)
- Subarticular sclerosis (increased density of bone along joint lines)
- Subchondral cysts (fluid filled holes in bones)
7
Q
CLINICAL FEATURES
Presentation
A
- Joint pain and stiffness
- Worse with activity and at end of day, contrary to inflammatory arthritis
- Bulky, bony enlargment of joint
- Restricted range of motion
- Crepitus on movement
- Effusions (fluid) around joint
8
Q
CLINICAL FEATURES
Signs in hands
A
- Heberden’s nodes (DIP joints)
- bouchards nodes (PIP joints)
- Squaring at base of thumb
- Weak grip
- Reduced range of motion
9
Q
Where does Heberdens and Bouchards nodes occur
A
Heberdens - DIP joints
Bouchard - PIP joints
10
Q
INVESIGATION
First choice
A
- Diagnosis can be made without investigation if
- >45 years
- Typical pain with activity
- No morning stiffness
- X-ray affected joints
- Serum CRP - normal, differentiate inflammatory arthritis
- Serum ESR - normal, differentiate inflammatory arthritis
11
Q
MANAGEMENT
General principles
A
- Patient education
- Lifestyle changes
- Analgesia in stepwise approach
- Topical capsaicin
- Steroid injections
- Joint replacement
12
Q
MANAGEMENT
Lifestyle changes
A
- Weight loss
- Physiotherapy
- Occupational therapy - devices and adaptations at home
- Orthotics - knee braces to support function
13
Q
MANAGEMENT
Analgesia stepwise approach
A
- Oral paracetamol and topical NSAID
- Add oral NSAID (maybe also proton pump inhibitor to protect stomach)
- Consider opiates such as codeine
14
Q
MANAGEMENT
Intra-articular steroid injection
A
- Methylprednisolone acetate
- Or triamcinolone acetonide
15
Q
NSAID SE
A
- GI
- Gastritis and peptic ulcers
- Renal
- AKI
- CVS
- Hypertension, heart failure, MI, stroke
- Exacerbating asthma
