Osteoarthritis

Question 1

Osteoarthritis

Answer 1

Wear and tear in the joints

Not an inflammatory condition

Occurs in the synovial joints and results from combination of genetic factors, overuse and injury

Question 2

Risk factors

Answer 2

Obesity

Age

Occupation

Trauma

Being female

Family history

Question 3

Commonly affected joints

Answer 3

Hips

Knees

Sacro-iliac joints

DIP

CMC

Wrist

Cervical spine

Question 4

Key features on xray

Answer 4

Loss of joint space

Oseteophytes (bone spurs)

Subarticular sclerosis (increased density of the bone along the joint line)

Subchondral cysts (fluid-filled holes in the bone)

Question 5

Presentation

Answer 5

Joint pain and stiffness worse with activity and at the end of the day

Bulky, bony enlargement of the joint

Restricted ROM

Crepitus on movement

Effusions (fluid) around the joint

Question 6

Signs in the hands

Answer 6

Heberden’s nodes (DIP)

Bouchard’s nodes (PIP)

Squaring of the thumb at the CMC

Weak grip

Reduced range of motion

Question 7

Diagnosis

Answer 7

Can be made without investigations if >45, has typical pain associated with activity and has no morning stiffness or stiffness lasting <30 minutes

Question 8

Management- conservative

Answer 8

Weight loss

Physiotherapy

Occupational therapy

Orthotics

Question 9

Analgesia

Answer 9

Oral paracetamol and topical NSAIDs

Add oral NSAIDs (consider prescribing PPI to protect stomach)

Consider opiates such as codeine

Topical capsaicin cream may be helpful

Question 10

Further management

Answer 10

Intra-articular steroid injections provide temporary reduction in inflammation and improve symptoms

Joint replacement can be used in severe cases

Question 11

NSAID side effects

Answer 11

GI: gastritis and peptic ulcers

Renal: AKI or progressive kidney disease

Cardio: HTN, HF, MI, stroke

Exacerbating asthma