Osteoarthritis Flashcards
What is osteoarthritis?
What are the key joint changes?
Which joints are affected by osteoarthritis?
Non-inflammatory degenerative joint disease characterised by desturction of hyaline cartilage and formation of new bone i.e. imbalance between destruction and repair
Loss of joint space Osteophyte formation Thinned hyaline cartilage Bone on bone erosion Subchondral cysts- secondary to destruction of cartilage + sclerosis of subchondral bone
Synovial joints i.e. large joints Hips Knees Sacro-iliac joints DIP (distal inter phalangeal joints) CMC at base of thumb (carpometacarpals) Wrist Cervical spine= cervical spondylosis
What are the key presentations of someone with osteoarthritis? How does this differ to inflammatory arthritis?
Joint pain and stiffness
Worsens with activity + relieved by rest
I.e. inflammatory improves with activity
No morning stiffness
I.e. inflammatory has stiffness in morning lasting >30 mins
Usually only ONE joint effected
Deformity
Instability of joint
Reduced function of joint
What are the classical signs of osteoarthritis in the hands?
Heberdens nodes= DIP
-way to remember= hebredies are far away and heberdens nodes are in DISTAL joint
Bouchard nodes= PIP
Squaring at CMC
Weakened grip
Reduced range of motion
What are the risk factors for osteoarthritis?
Joint overuse Trauma to joint i.e. joint intensive sports Age Poor posture Obesity Certain occupations Previous injury FH Diabetes Hypothyroidism RA Gout Pagets disease
How can osteoarthritis be managed non-medically?
Losing weight to decrease the strain on joint
Physiotherapy to help strengthen the joint
Occupational therapy i.e. to maximise the remaining function of joint
Orthotics
How can osteoarthritis be managed medically?
STEP WISE
Oral paracetamol
Topical NSAIDs
Topical capsaicin i.e. chilli extract which warms the joint and causes symptomatic relief
Oral NSAIDS +/- PPI (to protect stomach)
Opiates i.e. codeine and morphine
Intra-articular steroid injections
Joint replacement or joint re-surfacing
What shouldn’t opiates be used to treat the chronic pain associated with osteoarthritis?
Body adapts and becomes dependent and dose no longer providing any relief
What are the key differences between OA and RA?
OA involves DIP, RA doesn’t
OA tends to effect one large joint, RA effects multiple small joints
OA associated with morning stiffness <30 mins and pain which worsens with movement
What are the classic Xray features for OA?
LOSS (I)
Loss of joint space
Osteophytes= bony spurs projecting laterally
Subchondral sclerosis= increased density of bone along joint line which appears whiter than surrounding bone
Subchondral cysts= fluid-filled holes in bone i.e. appear are darker area w/ clear margines
Intra-articular loss bodies
What additional Xray features can be seen in the small joints of the hands?
Heberdens nodes (DIP)
Bouchards nodes (PIP)
How would you summarise osteoarthritis?
Non-inflammatory mono or oligo-arthritis typically of large joints
