Osteoarthritis

Question 1

Definition

Answer 1

Inflammatory degenerative joint disorder = loss of cartilage at synovial joints, and is often accompanied by degeneration of the underlying bone = joint pain and functional limitation:
Typically effects knees, hips, hands, and spine (cervical and lumbar)

Question 2

Epidemiology

Answer 2

Female
Increasing age (+45)

Question 3

Risk factors/ Aetiology

Answer 3

Non-modifiable:
- Family history
- Genetic predisposition (COL2A1)
Modifiable:
- Obesity
- Manual labour/ Exercise stresses
- Previous joint injury + damage
- Hypermobility

Question 4

Pathophysiology

Answer 4

Degradation of articular cartilage and impaired remodelling of bone due to active response of chondrocytes in the articular cartilage + inflammatory cells (chondrocyte metalloproteinase secretion) in the surrounding tissues = degrades T2 collagen and causes and subchondral bone cysts
The exposure of underlying subchondral bone results in sclerosis, followed by reactive remodelling changes (using T1 collagen) that lead to the formation of osteophytes. The joint space is progressively lost over time

Question 5

Signs

Answer 5

Hands:
Heberden’s nodes: bony swelling at the distal interphalangeal joint (DIP)
Bouchard’s nodes: (also seen in rheumatoid arthritis) – bony swelling at the proximal interphalangeal joint (PIP)
* HB nodes = asymmetrical, hard, non inflamed
Thenar muscle wasting
First carpometacarpal joint (base of thumb): most typically affected
Knee:
Fixed flexion deformity or misalignment in the knees
Feel crepitus throughout range of movement

Question 6

Symptoms

Answer 6

Joints effected: small joints of hands, feet and hip and knee
Symptoms are insidious, chronic and gradually worsening
Symptoms worsened by activity and relieved by rest:
- Pain worsens throughout day
- Stiffness improves
Stiffness in the morning:
- reduced range of movement (<30 minutes)
Joint locking:
- inability to straighten the joint, particularly common at the knee

Question 7

Diagnosis

Answer 7

FIRST LINE + GOLD STANDARD = X-ray of the hands knees and feet = LOSS
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts
Bloods = NORMAL
* Primarily a clinical diagnosis *

Question 8

Treatment

Answer 8

Life style changes;
- weight loss
- physiotherapy
- heat and cold patches
Medical (FIRST LINE):
- Paracetamol
- Non topical NSAIDS = hand or knee involvement
Medical (SECOND LINE):
- Weak opioids: CODIENE
- Topical capsaicin: hand and knee involvement
- Intra-articular corticoid injections: moderate to severe pain
Last resort:
- Consider surgery = arthroplasty for knee and hip replacement

Question 9

Complications

Answer 9

Joint effusions
Chronic pain