Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

BONE JOINT INFLAMMATION
-it is characterised by the progressive degeneration, destruction and erosion of the articulate cartilage (this therefore means that the cartilage is being worn down and thus the bones are able to rub against one another)

Question 2

Why is the cartilage important in the bones?

Answer 2

-allows lubrication of the bones
-prevents friction and pain.

Question 3

How is rheumatoid arthritis different to osteoarthritis?

Answer 3

RA essentially consists of bone erosion, there is a inflamed and swollen synovial membrane
-thus the bone erodes the immune system begins to attack the joint
-symmetrical
-can prolong past the 30 minutes after waking.
-autoimmune disease, this the your own antibodies attacking the joint.

Osteoarthritis just consists of thinned cartilage and the rubbing of the bones causing destruction of the bones
-asymmetrical
-morning stiffness lasting less than 30 minutes.

Question 4

What does osteoarthritis cause?

Answer 4

-reduced movement
-painful movement

Question 5

Is osteoarthritis symmetrical or asymmetrical and why?

Answer 5

OA is asymmetrical, which therefore means that it could happen in one hip and not the other.

Question 6

What are the symptoms of osteoarthritis?

Answer 6

-pain
-stiffness
-morning stiffness lasting less than 30 minutes.

Question 7

What are the symptoms of Rheumatoid arthritis?

Answer 7

-pain
-stiffness
-inflammation
-morning stiffness lasts more than 30 minutes.

Question 8

Which joints are most affected in osteoarthritis?

Answer 8

-knee
-hip
-hand and wrist

Question 9

What are the common occupational risk factors for osteoarthritis?

Answer 9

• occupational risk e.g heavy lifting etc
  -bending of the knees
  -kneeling
  -squatting
  -standing for too long e.g 2 hours per day
  -regular stair climbing

Question 10

What are the risk factors of developing osteoarthritis?

Answer 10

-bio mechanical( lifting etc)
-genetics (higher risk factor)
-biological

Question 11

What chromosome links osteoarthritis with genetics?

Answer 11

2q13-32
- if there is a mutation in this gene you are more likely to develop osteoarthritis.

Question 12

What happens in the different stages of osteoarthritis?

Answer 12

1. In the early stages, essentially the cartilage will develop irregularities at the surface where it will become more fibrillated.

2.as it progresses, there will be deep clefts seen forming within the cartilage, with losses of aggrecan and type II collagen within the cartilage extracellular breakdown.(loss of structural proteins)

3.chrodrocytes start to clump with the cartilage, surround the regions of intense staining material inidcating increased proteoglycan.

4. Loss of cartilage, loss of movement, increased friction between the joints.,

Question 13

What maintains the bones?

Answer 13

-osteoclasts
-osteoblasts

The level of these both dictate the mainlanders of the bones.
If there is an imbalance between the two this can lead to osteoarthritis.

Question 14

What are osteophytes and what effect do they have?

Answer 14

These are essentially bone spurs.(e.g. bone growing where it shouldn’t be e.g. in the joint)
- it can limit the space within the joint
-they can pinch nerves and be very painful
These occur in the
-neck
-shoulder
-knee
-lower back
-fingers
Etc

Question 15

What symptoms are involved with osteoarthritis?

Answer 15

-clicking or cracking sounds on joints
-slow onset
-mild swelling
-asymmetric
-reduced flexibility and motility
-stiffness
-Pain in the knees etc
-bone spurs

Question 16

How do we diagnose osteoarthritis?

Answer 16

1.medical history- check the patients symptoms

2.physical examination- see any bone spurs

3. X-ray

4.MRI scan

5.fluid inspection- observe any infection/ any crystals in the joint, which is subjective of gout, we want to rule this out.

Question 17

What is primary and secondary osteoarthritis?

Answer 17

PRIMARY=
-no known cause (onset over time, e,g, old age)
-seen in elderly
-more common

SECONDARY=
-linked to an existing disease for example gout, hemochrombtosis (which is the build up of iron in the blood)
-hormonal or inflammatory disorder
-joint injuries
-seen in younger patients
-less common

Question 18

How do we manage osteoarthritis?

Answer 18

Non pharmacological: (Want to lessen the impact on joints)
-exercise and manual therapy (weight loss) (muscle strengthening)
-if a person is unable to lose weight consider gastric bypass surgery

-joint aids and supports (braces, shoe wedges, insoles,walking aids e.g. walking sticks,frames

-TENS (transcutaneous electricAL NERVE STIMULATION)
-put pads on the affected area, blocks pain signals.

-surgical joint replacement:
If all treatments are not effective
-joint fusion, fuse the joint to stop movement completely.
-bones thus wont hurt
-remove small bones
-hip or knee replacement.

-nutraceuticals

Pharmacological:
-paracetamol
-NSAIDs
-capsaicin
-corticosteroids
-POTENTIALLY DMARDS , THEY ARE NOT APPROVED YET

Question 19

What is the overall aim in the treatment and management of osteoarthritis?

Answer 19

This is to reduce the pain, stiffness the patient is currently experiencing and to prevent further joint damage that could occur

Question 20

What are nutraceuticals and what are their benefit on osteoarthritis patients?

Answer 20

THEY ARE DIETARY SUPPLEMENTS e.g. glucosamine, chrondrotin

-they possibly stimulate chondrocytes, these produce the structural components of the cartilage e.g. collagen etc

-nice states to not use these as a management strategy to treat osteoarthritis

Question 21

What did hyaluronic acid claim to do in the improvement of osteoarthritis?

Answer 21

-initially thought to support elasticity of joints

-aids synovial fluid

-NOT RECOMMENDED AGAIN BY NICE

Question 22

What is first line treatment of osteoarthritis?

Answer 22

PARACETAMOL, however nice have found reduced effectiveness.

Question 23

What is third line if the patient is unresponsive to paracetamol ?

Answer 23

OPIOIDS with paracetamol
E.g. co-codamol

Question 24

What is second line treatment of osteoarthritis?

Answer 24

NSAIDs
-cox 2 inhibitors
-consider topical first over oral nsaids
-oral =give naproxen (LESS VASCULAR RISK) or ibuprofen
-consider GI ,renal and cardiovascular risk
IF NSAIDs ARE CAUSING GI DISTURBANCES THEN PRESCRIBE WITH A PPI.

Question 25

How are corticosteroids implemented into the treatment plan ?

Answer 25

INTRA ARTICULAR injections every 3 months using an ultrasound straight into the joint.

E.g. for moderate and severe pain

-hydrocortisone (most popular)
-dexamethasone
-prednisolone

REDUCES PAIN AND INFLAMMATION.

Question 26

What is topical capsaicin?

Answer 26

-active components of chilli peppers and analgesic properties.

-repeated treatment of capsaicin essentially produces desensitisation and inactivates the sensory neurons to eliminate pain.

Question 27

What are the risk factors of osteoarthritis?

Answer 27

-overweight or obese
-long term repetitive joint strain
-previous joint injury

Question 28

What lifestyle advice would you give to a patient with osteoarthritis?

Answer 28

-recommend weight loss only if appropriate
-exercise e.g. non weight bearing exercises e.g. build up muscle like swimming
-engage with supportive therapies such as physio.