Osteoarthritis Flashcards
Risk factors for osteoarthritis
Obesity Age Occupation Trauma Female Family history
Four key X-ray changes
L – Loss of joint space
O – Osteophytes
S – Subchondral sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone, aka geodes)
Presentation of OA
Joint pain and stiffness
Worsened by activity
Can lead to deformity, instability and reduced function in the joint.
Commonly affected joints
Hips
Knees
Sacro-iliac joints
Distal-interphalangeal joints in the hands (DIPs)
The CMC joint at the base of the thumb
Wrist
Cervical spine
Signs of OA in the hands
Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb at the carpo-metacarpal joint
Weak grip
Reduced range of motion
Why is the CMC at the base of the thumb particularly at risk of OA?
It gets a lot of use from everyday activities.
This makes it very prone to wear when used for complex movements.
Diagnosis and investigations
Diagnosis can be made clinically without investigations if patient is over 45, has typical activity related pain and has no morning stiffness or stiffness lasting less than 30 minutes.
I.e. in typical OA features, the diagnosis is clinical
Possible investigations
Joint X-ray –> often not needed
- If there is diagnostic uncertainty perhaps
Management of OA - non-conservative
Stepwise analgesia:
- Oral paracetamol and topical NSAIDs or topical capsaicin
- Add oral NSAIDs (and consider PPI cover)
- Consider opiates e.g. codeine, morphine
Intra-articular steroid injections provide temporary reduction in inflammation and symptom improvement
Joint replacement in severe cases
Management of OA - conservative
Weight loss if overweight to reduce load on the joint
Keep active with regular low strain exercise
Physiotherapy to improve joint strength
