osteoarthritis

Question 1

what is osteoarthritis

Answer 1

described as wear and tear in the synovial joints

it is not inflammatory

thought to result from an imbalance between the cartilage wearing down and the chondrocytes repairing it > leading to structural issues in the joint

Question 2

risk factors for OA

Answer 2

obesity
age
occupation
trauma
being F
family history

Question 2

commonly affected joints

Answer 2

hips
knees
sacra-iliac
distal-interphalangeal joints in the hands
the carpometacarpal joint at the base of the thumb
wrist
cervical spine

Question 3

what are the 4 key X-ray changes
(LOSS)

Answer 3

Loss of joint space
Osteophytes (bone spurs)
Subarticular sclerosis
Subchondral cysts

Question 4

how does OA present

Answer 4

presents with joint pain and stiffness

worse with activity and at the end of the day

-bulky bone enlargement of the joint
-restricted range of motion
-crepitus on movement
-effusions around the joint

> patients will often have referred pain

Question 5

how does OA present in the hands

Answer 5

Heberdens nodes
Bouchards nodes
Squaring at the base of the thumb at the carpometacarpal joint
Weak grip
reduced range of motion

Question 6

diagnosis for OA

Answer 6

NICE*

diagnosis can be made without any investigations if the patient is:
over 45
has typical pain associated with activity
and has no morning stiffness

Question 7

management

Answer 7

NICE*

start with patient eduction on…
weight loss
physiotherapy
occupational therapy
orthotics

analgesia:
1. oral paracetamol and topical NSAIDS
2. oral NSAIDS (consider co prescribing a PPI to protect stomach)
3. consider opiates

topical capsaicin
intra-articular steroid injections
joint replacement in severe cases

Question 8

why to be wary of NSAIDS use

Answer 8

can cause
gastritis
peptic ulcers
acute kidney injury or progressive kidney disease
HPT HF MI and stroke
exacerbating asthma

Question 9

pathophysiology

Answer 9

imbalance between cartilage wearing down + chondrocytes repairing it