Osteoarthritis

Question 1

What are the features of osteoarthritis?

Answer 1

Non-inflammatory arthritis
Degenerative disease of entire joint
80% >65yrs

Question 2

What are the risk factors for OA?

Answer 2

Obesity
Injury
Coexisting disease
Female

Question 3

What is the presentation of OA?

Answer 3

Joint pain, stiffness, swelling
Stiffness typically worse on exertion, worse at end of day
Deformity
Disability - walking distance, stairs, giving way

Question 4

What signs may be seen in OA?

Answer 4

Asymmetrical oligoarthritis, DIP J involvement

Bouchard’s and Heberden’s nodes

Question 5

What investigations are done in OA?

Answer 5

Bloods - normal
Imaging - Xray
Joint aspiration to exclude other causes

Question 6

What are the xray findings in OA?

Answer 6

Loss of joint space
Osteophytes
Subchondral cysts
Sclerosis

Question 7

What does joint aspirate look like in OA?

Answer 7

Sterile, viscous fluid

Question 8

What is the first line treatment for OA?

Answer 8

Conservative
Weight loss, exercise, PT, walking aids, avoid exacerbating activity
Paracetamol, topical NSAIDs (hands/knee)

Question 9

What is the second line treatment for OA?

Answer 9

Oral NSAIDs, opioids, capsaicin cream

Intra-articular steroids

Question 10

What is third line treatment for OA?

Answer 10

Joint replacement surgery

Question 11

What previous history is relevant in OA?

Answer 11

Trauma/infection
Treatments given (physio/injections/operations)
Other joints affected

Question 12

What are the operative management options for OA?

Answer 12

Replace (knee/hip)
Realign (knee/big toe)
Excise (toe)
Fuse (big toe)
Synovectomy (rheumatoid)
Denervate (wrist)