Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

Mechanical degradation of the joint with degeneration of the articular cartilage, periarticular bone remodelling & inflammation

Question 2

What are the primary OA risk factors?

Answer 2

Increased age 
Obesity 
Family history 
Female 
Sports activities

Question 3

What are the secondary causes of OA?

Answer 3

Trauma
Pre-existing joint damage: RA, gout, spondyloarthropathy, septic arthritis, Paget’s disease, avascular necrosis
Metabolic disease: chondrocalcinosis, haemachromatosis, acromegaly
Systemic disease: haemophilia, neuropathy, haemoglobinopathy

Question 4

What are the clinical features of OA?

Answer 4

Joint pain, worse on movement improves on rest

Morning pain <30mins

Question 5

Commonly affected joints in OA?

Answer 5

DIPs & PIPs
Carpometacarpal joint of thumb 
Wrist 
Knees 
Hips

Question 6

Signs of OA

Answer 6

Crepitus
Pain on movement
Reduced ROM
Bony swellings, joint instability, joint effusions

Question 7

Investigations

Answer 7

X rays

Bloods: WCC ESR CRP - to rule out inflammatory causes

Question 8

Changes seen on X-ray in OA?

Answer 8

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 9

Diagnosis can be made in?

Answer 9

Anyone >45 without ix if they have typical activity related pain & no morning stiffness or stiffness lasting less than 30 mins

Question 10

Management of OA

Answer 10

Conservative –> physiotherapy, weight loss, mobility aids, supportive footwear
Analgesia: topical analgesia (capsaicin, NSAIDs), add paracetamol, add NSAID, add opioid
Intra-articular corticosteroid injections
Joint replacement