Osteoarthritis

Question 1

What is OA?

Answer 1

Cartilage degradation + bone remodelling

Question 2

What is OA caused by? (2 things)

Answer 2

Active response of:

1. Chondrocytes in articular cartilage
2. Inflamm cells in surrounding tissue

Question 3

How do chondrocytes and inflamm cells degrade cartilage? (2 steps)

Answer 3

1. Release enzymes

2. Enzymes break down collagen + proteoglycans

Question 4

Once the cartilage is degraded, what does underlying subchondral bone exposure result in? (3 things)

Answer 4

1. Subchondral Sclerosis (thickening of bone)
2. Osteophyte formation
3. Subchondral bone cyst formation

Question 5

What are the risk factors for PRIMARY OA? (4 things)

Answer 5

1. Obesity
2. Age
3. Female
4. Manual labour occupations

Question 6

What are the risk factors for SECONDARY OA? (3 things)

Answer 6

1. Trauma
2. Infiltrative disease
3. CT diseases

Question 7

What are the most common joints affected in OA? (4 things)

Answer 7

1. Hands
2. Feet
3. Hip
4. Knee

Question 8

What are the clinical features of OA? (4 things)

Answer 8

1. Pain
2. Stiff joints
3. Deformity (prolonged OA)
4. Reduced range of movement (prolonged OA)

Question 9

What makes joint stiffness worse and better in OA?

Answer 9

Worse = activity
Better = rest

Question 10

What is different about pain + stiffness in OA in comparison with RA?

Answer 10

OA = pain worse thru day, stiffness improves thru day
RA = pain + stiffness improve w activity

Question 11

What are the HAND deformities you should examine for in sus OA? (2 things)

Answer 11

1. Bouchard nodes (PIPJ swelling)

2. Heberden nodes (DIPJ swelling)

Question 12

What are the KNEE deformities you should examine for in sus OA? (2 things)

Answer 12

1. Fixed flexion deformity

2. Varus malalignment

Question 13

What should you FEEL for on examination of sus OA?

Answer 13

Crepitus throughout range of movement

Question 14

What are some differential diagnosis’ of sus OA? (6 things)

Answer 14

1. RA
2. Crystal arthropathies (gout)
3. Septic arthritis
4. # s
5. Bursitis
6. Malignancy

Question 15

On what basis is OA diagnosis made?

Answer 15

Clinically

Question 16

How do you exclude DD of OA? (2 things)

Answer 16

1. Routine bloods = exclude inflamm / inf causes

2. Radiographs = confirm diagnosis / exclude #s

Question 17

What are the radiological features of OA? (4 things)

Answer 17

1. Loss of joint space
2. Subchondral sclerosis
3. Osteophytes
4. Subchondral cysts

Question 18

What are the Conservative management options of OA? (4 things)

Answer 18

1. Joint strengthening + exercise
2. Physio
3. Weight loss if overweight
4. Local heat / ice packs

Question 19

What are the Medical management options of OA? (3 things)

Answer 19

1. Analgesia
2. Topical NSAIDs
3. Intra-articular steroid injections

Question 20

What are the Surgical management options of OA? (3 things)

Answer 20

1. Osteotomy (cutting bone)
2. Arthrodesis (joint fusion)
3. Arthroplasty (joint replacement)

Question 21

What is a complication of OA?

Answer 21

Meniscal tear

Question 22

How does OA cause meniscal tears, and what does this cause?

Answer 22

Rough cartilage from OA tears the meniscus –> synovial fluid leaks out causing cysts behind / in front of knee