Osteoarthritis

Question 1

OA OVERVIEW
i) what is it? is it inflammatory? which type of joints does it occur in? name three things that can contribute to it
ii) which two things is it a balance between? name four RFs
iii) what are the four key x ray changes? (LOSS) do these changes correlate with symptoms?

Answer 1

i) wear and tear in the joints that is not inflammatory
occurs in synovial joints and results from combo of genetic factors, over use and injury
ii) balance between cartilage wearing down and chondrocytes repairing it
RFs - obesity, age, occupation, trauma, female, FH
iii) Loss of joint space, Osteophytes, Subarticular sclerosis (inc density of bone along the joint line) and Subchondral cysts (fluid filled holes in bone)
dont correlate with symptoms - can have severe x ray change and not many symptoms

Question 2

OA PRESENTATION
i) which two things does it principally present with? what worsens the symptoms? at what time of day?
ii) name three general signs
iii) name four signs that are seen in the hands? which joint can be specifically prone to wear?
iv) which three things can be used to diagnose a person over 45 without doing any investigations?

Answer 2

i) presents with joint pain and stiffness that are worse with activity and at the end of the day
ii) bulky bone enlargement of joint, restricted range of motion, crepitus on movement, joint effusions
iii) see heberdens nodes (DIPs), bouchards nodes (PIPs), squaring at base of thumb at CMCP joint, weak grip, reduced range of motion
carpometacarpal joint (base of thumb) is more prone to wear = saddle joint
iv) typical pain, assoc with acitivty and no morning stiffness or stiffness lasting under 30min

Question 3

OA MANAGEMENT
i) name three lifestyle changes that can be implemented in the first instance
ii) which analgesia should be given first (2), what can then be added? what can be given third line?
iii) name three other things that can be given to relieve pain/inflamm?

Answer 3

i) weight loss, physio, occupational therapy and orthotics
ii) paracetamol and topical NSAIDs first
then add oral NSAIDs with a PPI
then opiates eg codiene third line
iii) topical capsaicin, intra articular steroid injections and joint replacement in severe cases

Question 4

NSAID SIDE EFFECTS
i) name two GI side effects
ii) name two renal side effects
iii) name two CV side effects
iv) name another thing that NSAIDs can exacerbate

Answer 4

i) gastritis and PUD
ii) AKI (ATN), progressive kidney disease
iii) high BP, HF, MI, stroke
iv) can also exacerbate asthma