Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

Osteoarthritis is often described as “wear and tear” in the joints. It is not an inflammatory condition like rheumatoid arthritis. It occurs in the synovial joints and results from a combination of genetic factors, overuse and injury.

Osteoarthritis is thought to result from an imbalance between the cartilage wearing down and the chondrocytes repairing it, leading to structural issues in the joint.

Question 2

Risk factors of osteoarthritis

Answer 2

obesity, age, occupation, trauma, being female and family history.

Question 3

Commonly Affected Joints in osteoarthritis

Answer 3

Hips
Knees
Sacro-iliac joints
Distal-interphalangeal joints in the hands (DIPs)
The carpometacarpal joint at the base of the thumb (CMC)
Wrist
Cervical spine (cervical spondylosis)

Question 4

Four Key X-ray Changes in osteoarthritis

Answer 4

L – Loss of joint space
O – Osteophytes (bone spurs)
S – Subarticular sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone)

(LOSS)

X-ray changes do not necessarily correlate with symptoms. Significant x-ray changes might be found incidentally in someone without symptoms. Equally, someone with severe symptoms of osteoarthritis may have only mild changes on an x-ray.

Question 5

General signs of osteoarthritis are:

Answer 5

Bulky, bony enlargement of the joint
Restricted range of motion
Crepitus on movement
Effusions (fluid) around the joint

Question 6

Is pain and stiffness worse or better with activity?

Answer 6

s tends to be worse with activity and at the end of the day, in contrast to inflammatory arthritis, where activity improves symptoms and the symptoms tend to be worse first thing in the morning. Osteoarthritis leads to deformity, instability and reduced function of the joint.

Question 7

Signs in the Hands?

Answer 7

Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb at the carpometacarpal joint (saddle joint at the base of the thumb)
Weak grip
Reduced range of motion

Question 8

Diagnosis of osteoarthritis

Answer 8

The NICE guidelines (updated 2020) suggest that a diagnosis can be made without any investigations if the patient is over 45, has typical pain associated with activity and has no morning stiffness (or stiffness lasting under 30 minutes).

Question 9

Management of osteoarthritis: lifestyle changes:

Answer 9

The NICE guidelines recommend a holistic approach to managing patients with osteoarthritis. It is a long-term condition that can be difficult to manage. Start with patient education about the condition and advise on lifestyle changes such as:

Weight loss if overweight to reduce the load on the joint
Physiotherapy to improve strength and function
Occupational therapy to support activities and function (e.g., special devices and adaptations to the home)
Orthotics to support activities and function (e.g., knee braces)

Question 10

Management: Medical?

Answer 10

The use of analgesia involves a stepwise approach to control symptoms:

Oral paracetamol and topical NSAIDs
Add oral NSAIDs (consider co-prescribing a proton pump inhibitor, such as omeprazole, to protect the stomach)
Consider opiates such as codeine

Topical capsaicin (chilli pepper) cream may be helpful, where available.

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

Joint replacement can be used in severe cases. The hip and knee are the most commonly replaced joints.