Osteoarthritis

Question 1

What is the epidemiology?

Answer 1

Women
Increases with age

Question 2

What are the most common joints?

Answer 2

Knee
Hand
Hip

Question 3

What is the aetiology?

Answer 3

Primary: wear and tear/degenerative mechanical damage associated with ageing

Secondary: pre-existing cause
- Haemochromatosis
- Ehlers-Danlos
- Diabetes

Question 4

What is the pathophysiology of osteoarthritis?

Answer 4

First:
- Degeneration of articular cartilage

Later:
- Fibrillation in the cartilage which spreads to the subchrondral bone
- Synovial fluids leaks into bone
- Chondrocyte proliferation and formation of fibrocartilage plugs

End Dx:
- Loss of joint space
- Osteophytic spurs
- Subchondral cysts
- Eburnation of the joint = complete loss of hyaline cartilage

Question 5

What is the presentation of osteoarthritis?

Answer 5

Mechanical pain!!
- Worse with activity
- Relieved with rest
- Gradual onset over months to years

Large weight bearing joints: knees, hips but also the hands

Morning stiffness is SHORT

Question 6

What are the feature on Ex of osteoarthritis?

Answer 6

Decreased ROM
Crepitus
Small joint effusions
Nodes: heberdens (DIP), Bouchards (PIP)
Sometimes palpable osteophytes

Question 7

What Ix do you do?

Answer 7

Imaging:
- Joint space narrowing
- Subchondral sclerosis and cysts
- Osteophytes
- Soft tissue swelling

Question 8

What is the Ddx?

Answer 8

RA: rarely affects DIP
Septic arthritis
Gout; you’ll have inflammatory features

Question 9

What is the Mx?

Answer 9

Weight loss
regular weight bearing exercise
Targeted muscle growth
Topical analgesia

Medical:
Paracetamol, NSAIDs

Surgical:
Arthroplasty