Osteoarthritis Flashcards
arthritis definition
term used to mean any disorder that affects joints
symptoms normally include joint pain and stiffness
2 main categories of arthritis
inflammatory
non-inflammatory
different types of inflammatory arthritis
rheumatoid arhtritis
seronegative spondyloarthropathies
crystal arthritis
septic arthritis
what is osteoarthritis
clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life
most common form
clinical features of osteoarthritis
bony swelling
muscle aasting
deformity
palpable crepitus on movement
restricted painful movement
radiographic features of OA
joint space narrowing
osteophyte
subchondral sclerosis
subchondral cysts
what is in the image
normal knee x ray
what does the image show
clinical term for bunion
hallux valgus
x-rays are helpful to exclude
fracture
pages
pseudoogut
avascular necrosis
x rays not helpful to exclude
ligament/meniscal problems
inflammatory arthritis
tumour
infection
NICE OA management guidelines regarding OA diagnosis
persistent joint pain with use
aged 45+
any morning stiffness lasting no more than half an hour
no x ray needed
blood test results
usually normal
no place in diagnosis other than investigate other diagnoses
aetiology of OA
not just one disease
multiple risk factors
differs between sites
pathology, what is OA
metabolically active dynamic repair process
affects all joint tissues
some joint features of OA
cysts
cartilage fibrillation and erosion
marginal osteophyte
subchonral sclerosis
periosteal ostephyte
muscle atrophy
bursitis
capsular fibrosis
osteochondral body
synovial hyperplasia
enthesopathy
tissue loss
cartilage micro fracture
fragments break off
pitting and abrasion of cartilage
localised loss of hyaline cartilage
reactive changes
remodelling of adjacent bone
new bone formation
synovitis/effusion
reabsorption of necrotic fractured subchondral bone
why do x rays not correlate with symptoms
outcome of OA
outcome variable
progressive decline isn’t inevitable
radiographic improvement is rare
symptoms episodic
varies on site
hand improvement common
knee rule of thirds
one third mild symptoms/improve
one third moderate/stay same
one third severe/progress
different exercising to help
aerobic exercise
quadriceps strengthening
how does exercise help
improve pain
physical function
quality of life
balance
core management
education, and advice
strengthening exercise
weight loss if overweight
drugs to manage
paracetamol
topical NSAIDs
other management
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
dispelling myths in education
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
analgesic drugs
adjunctive to core treatments
Paracetamol first line
topical NSAIDs considered for knee or hand OA
what isn’t recommended for treatment
glucosamine
chondroitin
NICE states no evidence to support use of them in knee or hip
what may be used instead of paracetamol or topical NSAIDs
oral NSAID
COX-2 inhibitor
opioids
non-pharmacological treatment
hand therapy for joint protection
supports and braces
heat and cold
walking aids
footwear
intra-articular injections
improve pain and function for up to 6 weeks (knee)
evidence poor quality
joint replacement surgery
mainly hips and knees
symptoms having significant impact on quality of life
symptoms refractory to non-surgical treatment
DMOADs
disease modifying therapies for osteoarthritis
cartilage driven endocyte DMOAD for cartilage defects
proteinases inhibitors
fibroblast growth factor 18
Wnt signalling inhibitors
TGF beta
senolytic therapies
synovitis driven end-type for synovitis
diacerein
IL-1, TNF alpha
tocilizumab
XT-150
bone driven end-type for subchondral bone remodelling
cathepsin K inhibitor
parathyroid hormone
matrix extracellular
phosphoglycoprotein MEPE
vitamin D
bisphosphonate
what isn’t recommended in treatment
arthroscopic lavage unless clear history of mechanical locking
