Osteoarthritis

Question 1

arthritis definition

Answer 1

term used to mean any disorder that affects joints
symptoms normally include joint pain and stiffness

Question 2

2 main categories of arthritis

Answer 2

inflammatory
non-inflammatory

Question 3

different types of inflammatory arthritis

Answer 3

rheumatoid arhtritis
seronegative spondyloarthropathies
crystal arthritis
septic arthritis

Question 4

what is osteoarthritis

Answer 4

clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life
most common form

Question 5

clinical features of osteoarthritis

Answer 5

bony swelling
muscle aasting
deformity
palpable crepitus on movement
restricted painful movement

Question 6

radiographic features of OA

Answer 6

joint space narrowing
osteophyte
subchondral sclerosis
subchondral cysts

Question 7

what is in the image

Answer 7

normal knee x ray

Question 8

what does the image show

Answer 8

Question 9

clinical term for bunion

Answer 9

hallux valgus

Question 10

x-rays are helpful to exclude

Answer 10

fracture
pages
pseudoogut
avascular necrosis

Question 11

x rays not helpful to exclude

Answer 11

ligament/meniscal problems
inflammatory arthritis
tumour
infection

Question 12

NICE OA management guidelines regarding OA diagnosis

Answer 12

persistent joint pain with use
aged 45+
any morning stiffness lasting no more than half an hour
no x ray needed

Question 13

blood test results

Answer 13

usually normal
no place in diagnosis other than investigate other diagnoses

Question 14

aetiology of OA

Answer 14

not just one disease
multiple risk factors
differs between sites

Question 15

pathology, what is OA

Answer 15

metabolically active dynamic repair process
affects all joint tissues

Question 16

some joint features of OA

Answer 16

cysts
cartilage fibrillation and erosion
marginal osteophyte
subchonral sclerosis
periosteal ostephyte
muscle atrophy
bursitis
capsular fibrosis
osteochondral body
synovial hyperplasia
enthesopathy

Question 17

tissue loss

Answer 17

cartilage micro fracture
fragments break off
pitting and abrasion of cartilage
localised loss of hyaline cartilage

Question 18

reactive changes

Answer 18

remodelling of adjacent bone
new bone formation
synovitis/effusion
reabsorption of necrotic fractured subchondral bone

Question 19

why do x rays not correlate with symptoms

Answer 19

Question 20

outcome of OA

Answer 20

outcome variable
progressive decline isn’t inevitable
radiographic improvement is rare
symptoms episodic
varies on site
hand improvement common

Question 21

knee rule of thirds

Answer 21

one third mild symptoms/improve
one third moderate/stay same
one third severe/progress

Question 22

different exercising to help

Answer 22

aerobic exercise
quadriceps strengthening

Question 23

how does exercise help

Answer 23

improve pain
physical function
quality of life
balance

Question 24

core management

Answer 24

education, and advice
strengthening exercise
weight loss if overweight

Question 25

drugs to manage

Answer 25

paracetamol topical NSAIDs

Question 26

other management

Answer 26

oral NSAIDs capsaicin opioids intra articular corticosteroid injections local heat and cold applications assistive devices joint arthroplasty manual therapy transcutaneous electrical nerve stimulation shock absorbing shoes supports and braces

Question 27

dispelling myths in education

Answer 27

not inevitable cause of ageing not just wear and tear involves whole joint decline and joint replacement isn't inevitable, symptoms often improve effective non-surgical treatment available exercise

Question 28

analgesic drugs

Answer 28

adjunctive to core treatments Paracetamol first line topical NSAIDs considered for knee or hand OA

Question 29

what isn't recommended for treatment

Answer 29

glucosamine chondroitin NICE states no evidence to support use of them in knee or hip

Question 30

what may be used instead of paracetamol or topical NSAIDs

Answer 30

oral NSAID COX-2 inhibitor opioids

Question 31

non-pharmacological treatment

Answer 31

hand therapy for joint protection supports and braces heat and cold walking aids footwear

Question 32

intra-articular injections

Answer 32

improve pain and function for up to 6 weeks (knee) evidence poor quality

Question 33

joint replacement surgery

Answer 33

mainly hips and knees symptoms having significant impact on quality of life symptoms refractory to non-surgical treatment

Question 34

DMOADs

Answer 34

disease modifying therapies for osteoarthritis

Question 35

cartilage driven endocyte DMOAD for cartilage defects

Answer 35

proteinases inhibitors fibroblast growth factor 18 Wnt signalling inhibitors TGF beta senolytic therapies

Question 36

synovitis driven end-type for synovitis

Answer 36

diacerein IL-1, TNF alpha tocilizumab XT-150

Question 37

bone driven end-type for subchondral bone remodelling

Answer 37

cathepsin K inhibitor parathyroid hormone matrix extracellular phosphoglycoprotein MEPE vitamin D bisphosphonate

Question 38

what isn't recommended in treatment

Answer 38

arthroscopic lavage unless clear history of mechanical locking