Osteoarthritis Flashcards
Osteoarthritis epidemiology
- Most common condition affecting synovial joints/ common arthritis
- Most important condition relating to disability as result of locomotor symptoms
- 8.75 million people in the UK have sought treatment for OA
Expense of osteoarthritis
89,288 hip replacements and 98,591 knee replacements in England, Wales and Northern Ireland (2015)
> £ 1 bn
Impact to UK economy ~1% GNP (2008)
Lost days of work
Incapacity benefit
Treatment strategies
What is osteoarthritis?
- Osteoarthritis is an age-related, dynamic reaction pattern of a joint in response to insult or injury
- All tissues of the joint are involved
- Articular cartilage is the most affected
- Changes in underlying bone at the joint margins
Definition of osteoarthritis
characterised by progressive synovial joint damage resulting in structural changes, pain and reduced function. It is the ‘wear and tear’ of joints.
Can be primary or secondary
Pathogenesis
- Metabolically active and dynamic process
- Mediated by cytokines
- IL-1
- TNF-α
- NO
- Driven by mechanical forces
Main pathological features:
- Loss of cartilage
- Disordered bone repair
RF
Age
Due to:
Cumulative effect of traumatic insult
Decline in neuromuscular function
50% will have symptoms of OA
Females
OA hand and hip less common in black people
Obesity
Occupation - farming, football, manual labour
Joint injury/ trauma
Obesity is a RF why though?
Obesity is a low grade inflammatory state
Release of:
IL-1
TNF
Adipokines (leptin, adiponectin)
Linear relationship between BMI and risk of hip and knee OA
Symptoms of Osteoarthritis
- Joint Pain
Often reason patient seeks medical advice - May not be present despite significant changes on x-ray
- Mechanical locking
- Limited joint movement
- Functional impairment:
- Walking
- Activities of daily living
Signs
- Alteration in gait
- Joint swelling - bony enlargement, effusion, synovitis
- Limited ROM
- Tenderness
- Deformities
- Heberden’s nodes: swelling in distal interphalangeal joint (top finger joint)
- Bouchard’s nodes: swelling in proximal interphalangeal joint (middle finger joint)
- Fixed flexion deformity of carpometacarpal (base of thumb)
- Mucoid cysts: painful cyts found on dorsum of finger
Radiological features of osteoarthritis (V Important)
- Joint space narrowing
- Osteophyte formation
- Subchondral sclerosis
- Subchondral cysts
- Abnormalities of bone contour
A 70 year old man attends with painful, swollen finger joints
The pain is worse when he uses his hands, and towards the end of the day
There is morning stiffness in the joints, lasting 10-15 minutes each day
On examination there is bony swelling of all of the PIP and DIP joints bilaterally
OA of the Hands
DIP, PIP, CMC joints
Relapsing, remitting course over a few years
‘Nodal’ form has a strong genetic component
Each involved joint often has an early ‘inflammatory’ phase
Bony swelling and cyst formation
Reduced hand function
Heberden’s nodes at DIP joints
Bouchard’s nodes at PIP joints
A 70 year old lady presents with progressive pain in the knees
The pain is worse on exertion, particularly on using the stairs
She struggles with tasks around the house and has had to move in with her daughter
The pain frequently wakes her up from sleep
Knee OA
3 compartments
Medial (commonest)
Lateral
Patellofemoral
Any may be affected in isolation or in combination
Without significant trauma, evolution very slow
Once established, often remains stable for years
A 65 year old lady presents with increasingly severe pain in the right groin
It is becoming difficult to walk
The pain wakes her from sleep several times a night
Hip OA
A 55 year old man presents with pain and swelling of the small joints of the hands
The pain is worse on exertion, but also worse after prolonged rest
There is morning stiffness lasting an hour each day
On examination, there is bony swelling of the joints, inkeeping with nodal osteoarthritis, but there is also some additional soft-tissue swelling over the joints, with associated tenderness
His rheumatoid factor and anti-CCP are negative
Erosive / inflammatory OA
Subset of OA
Strong inflammatory component
In addition to standard management, DMARD therapy (usually milder agents) often used
A 64 year old woman with known osteoarthritis of the knees complains that her left knee frequently ‘locks’ in a flexed position
Loose body in the knee
Associated with ‘locking’ of knee
Bone or cartilage fragment
The only indication for arthroscopy in osteoarthritis
