Osteoarthritis Flashcards
Define osteoarthritis
- Thought to be natural “wear and tear” in the joints over time
- Progressive disorder of the joints caused by gradual loss of cartilage and resulting in the development of bony spurs and cysts at the margins of the joints
- Characterised by progressive synovial joint damage resulting in structural changes, pain and reduced function
- Typically, a progression of joint pain and stiffness over months/years
- Most common form of arthritis
Which arthritis is thought to be natural “wear and tear” in the joints over time
Osteoarthritis
What is the main risk factor for osteoarthritis
Obesity
Name some risk factors for osteoarthritis
Obesity
Age – more common over 45 years old
Occupation
Previous trauma to joints
Post-menopausal women
Family history
What is the key clinical feature of osteoarthritis
Joint pain and stiffness
The joint pain and stiffness associated with osteoarthritis tend to:
a) worse on rest and better with activity
b) worse with activity and better with rest
b) worse with activity and better with rest
Heberden’s nodes are associated with what kind of arthritis
Rheumatoid arthritis
Bouchard’s nodes are associated with what kind of arthritis
Rheumatoid arthritis
What are the two nodes associated with rheumatoid arthritis
Heberden’s nodes
Bouchard’s nodes
What joints are affected by Heberden’s nodes
Distal interphalangeal (DIP) joint
Think HD like in High Definition
What joints are affected by Bouchard’s nodes
Proximal interpharyngeal (PIP) joint
Remember it as BP like Blood Pressure
What joints are commonly affected by osteoarthritis
Large, weight bearing joints e.g. knee, hip and lumbar spine
The distal and proximal interphalangeal joints (DIP and PIP) of the hands
Sacro-iliac joints
First carpometacarpal joint (CMC) of the thumb
Cervical spine
Is morning stiffness associated with osteoarthritis?
No
Osteoarthritis is a clinical diagnosis and is made up of three components .
What are these three components
Over 45 year old
Typical activity related pain
No morning stiffness or stiffness lasting < 30 minutes
What is the gold standard investigation for osteoarthritis
X-Ray
What are the 4 X-Ray features of osteoarthritis
Mnemonic “LOSS”
L - Loss of joint space
O- Osteophytes
S - Subchondral cysts
S - Subarticular sclerosis
The management of osteoarthritis is a combination of pharmacological and non-pharmacological approaches.
Name some non-pharmacological approaches in managing osteoarthritis
Patient education
Advice on lifestyle changes, particularly weight loss to reduce the load on the joint
Physiotherapy to improve strength to support the joint
The management of osteoarthritis is a combination of pharmacological and non-pharmacological approaches.
Name the 3 potential pharmacological approaches in managing osteoarthritis
Analgesia
Intra-articular joint injection
Surgical management
What is the 1st line analgesia used in managing osteoarthritis
Paracetamol
Paracetamol is the 1st line choice for analgesic relief in managing osteoarthritis.
What are other potential analgesic choices
Topical NSAIDs or topical capsaicin, in particular for knee and hand osteoarthritis
Oral NSAIDs (+ PPI cover)
Consider opiates – can have significant side effects and don’t work great for chronic pain as the patients become dependent without benefitting from the analgesic effects
Opioid analgesia, after considering the risks, can be offered
What are the two potential risks for intra-articular joint injection
Septic arthritis (very rare)
Avascular necrosis
Describe the effect intra-articular joint injection has on managing osteoarthritis
Provides a temporary reduction in inflammation and improve symptoms
Short lived effects
What is the name for joint replacement surgery
Arthroplasty
When is joint replacement surgery (arthroplasty) indicated in managing osteoarthritis
Considered in severe cases, where the patients quality of life is impacted and it has not responded to non-surgical options
Describe the aetiology of osteoarthritis
Mechanically driven – “wear & tear”
localised loss of cartilage
remodelling of adjacent bone
associated inflammation
Describe the aetiology of rheumatoid arthritis
What gender is osteoarthritis more common in
Similar incidence in men and women
What gender is rheumatoid arthritis more common in
More common in women
What age is osteoarthritis more common in
Seen most commonly in the elderly
What age is rheumatoid arthritis more common in
Seen in adults of all ages
What joints are typically affected in osteoarthritis
Large weight-bearing joints (hip, knee)
Carpometacarpal joint
DIP and PIP joints
What joints are typically affected in rheumatoid arthritis
MCP and PIP joints
DIP if often spared
In which arthritis is the pain worse with use
a) osteoarthritis
b) rheumatoid arthritis
a) osteoarthritis
In which arthritis is the pain better with use
a) osteoarthritis
b) rheumatoid arthritis
b) rheumatoid arthritis
In which arthritis is the pain improves with rest
a) osteoarthritis
b) rheumatoid arthritis
a) osteoarthritis
In which arthritis is the pain worse with rest
a) osteoarthritis
b) rheumatoid arthritis
b) rheumatoid arthritis
In which arthritis is the symptoms commonly affect unilateral joints:
a) osteoarthritis
b) rheumatoid arthritis
a) osteoarthritis
In which arthritis is the symptoms commonly affect bilateral joints:
a) osteoarthritis
b) rheumatoid arthritis
b) rheumatoid arthritis
In which arthritis is associated with systemic upset:
a) osteoarthritis
b) rheumatoid arthritis
b) rheumatoid arthritis
In which arthritis does not have systemic upset associated with it:
a) osteoarthritis
b) rheumatoid arthritis
a) osteoarthritis
What are the three joints affected by osteoarthritis
PIP
DIP
Carpometacarpal joint
What are the two joints affected by osteoarthritis
DIP
MCP
Where are subchondral cysts located
Deep to the articular surfaces of the joints
Where are peri-articular erosions located
In the joint margins
Subchondral cysts is an unique x-ray change of which arthritis:
a) Osteoarthritis
b) Rheumatoid arthritis
a) Osteoarthritis
Peri-articular erosions is an unique x-ray change of which arthritis:
a) Osteoarthritis
b) Rheumatoid arthritis
b) Rheumatoid arthritis
Presence of osteophytes is an unique x-ray change of which arthritis:
a) Osteoarthritis
b) Rheumatoid arthritis
a) Osteoarthritis
Subchondral sclerosis is an unique x-ray change of which arthritis:
a) Osteoarthritis
b) Rheumatoid arthritis
a) Osteoarthritis
Describe the x-ray feature of subchondral sclerosis (x-ray feature of osteoarthritis)
Seen as increased density of the articular surface
