Osteoarthritis

Question 1

OA is a chronic disease characterised by?

Answer 1

1. Cartilage loss
2. Periarticular change

Question 2

Most commonly affected joints:

Answer 2

Knees, hands, hips

Question 3

Key pathological changes:

Answer 3

Localised loss of hyaline cartilage
+ remodelling of adjacent bone with new osteophyte formation at joint margins.

(Metabolically active process that affects all joint tissues - cartilage, bone, synovium, ligaments, muscle)

Question 4

Causes:

Answer 4

Genetic factors in 40-60%
Ageing, female sex, obesity
Biomechanical factors - occupation, hobbies, prior joint trauma, joint laxity/malalignment

Question 5

Development throughout the day?

Answer 5

Pain worse with joint use.
Morning stiffness less than 1 hour (if more than 1, consider rheumatoid)

Question 6

Examination features:

Answer 6

Joint line tenderness
Crepitus
Joint effusion
Bony swelling
Deformity
Decreased ROM

Question 7

Hand abnormalities:

Answer 7

Heberden’s nodes
Bouchard’s Nodes
Squaring of the thumbs (due to 1st CMC OA)

Question 8

Knee abnormalities:

Answer 8

Genu varus and valgus deformities
Baker’s Cysts

Question 9

Hip abnormalities:

Answer 9

Pain may be felt in groin/radiating to the knee
Pain felt in hip may be radiating from the lower back

Question 10

Spine abnormalities:

Answer 10

Cervical - may lead to occipital headaches
Osteophytes may impinge on nerve roots

Lumbar - Osteophytes can cause spinal stenosis if they encroach on the spinal canal

Question 11

Management:

Answer 11

Analgesia - topical steroids
Local intra-articular steroid injections

Surgical:
Joint replacements
Arthroscopic surgery to remove loose bodies etc

Question 12

Can symptoms improve?

Answer 12

Yes.

Small joints of hands - pain often improves (although swelling is persistent)
Knees - 1/3 improve, 1/3 stay stable, 1/3 deteriorate
Hips - Only 10% improve