Osteoarthritis

Question 1

History of osteoarthritis

Answer 1

-Pain and affecting PIP, DIP and 1st CMC joints (large weight bearing joints)= improves with rest, unilateral symptoms, swelling and joint deformity
-No systemic upset
-Knee pain (worse on descending stairs, sometimes effusion)
-Hip pain worse on weight bearing
-Back, neck and shoulder girdle pain
-Age at onset usually >50.

Question 2

Examination in osteoarthritis

Answer 2

-Bony swelling of affected joints in the hands, crepitus= restricted and painful range of joint movement
=Heberden’s and Bouchard’s nodes
-Crepitus on knee flexion
-Limitation of hip movement
-Pain on back, shoulder and neck movement
-Muscle wasting and weakness

Question 3

Investigations of osteoarthritis

Answer 3

-Routine bloods (usually normal)
-Anti-CCP antibodies (negative)
-X-ray of symptomatic joints
=Loss of joint space
=Osteophytes forming at joint margins
=Subchondral sclerosis
=Subchondral cysts

Question 4

Non-pharmacological treatment of osteoarthritis

Answer 4

-Explain that there is wear and tear of the joints and that although there is no cure, several treatments can help symptoms.
-Weight loss can make a big difference in patients with hip or knee OA (local muscle strengthening exercises and general aerobic fitness)
-Quadriceps exercise can help knee OA.
-Supports, braces, TENS, and shock-absorbing insoles or shoes

Question 5

Medical management of osteoarthritis

Answer 5

-Start with local therapy and add additional medications as necessary. It’s possible to use analgesics, NSAID and anti-neuropathic drugs in combination
-Paracetamol and topical NSAIDs first line
=Local NSAID cream for knee or hand
-Oral NSAID (with PPI), opioids, capsaicin cream, intra-articular corticosteroids
-Compound analgesics
-Anti-neuropathic agents (gabapentin or amitriptyline)
-Strong opioids as last resort.

Question 6

Joint replacement in osteoarthritis

Answer 6

-Selection: 25% patients younger than 60
-Cemented hip replacement, hip resurfacing

Question 7

Aetiology of osteoarthritis

Answer 7

-Mechanical wear and tear
=Localised loss of cartilage
=Remodelling of adjacent bone
=Associated inflammation
-Similar incidence in men and women, commonly in elderly

Question 8

Osteoarthritis of the hand

Answer 8

-Usually bilateral
-Episodic joint pain: An intermittent ache. Provoked by movement and relieved by resting the joint.
-Stiffness: worse after long periods of inactivity
-Painless nodes (bony swellings): Heberden’s nodes at the DIP joints, Bouchard’s Nodes at the PIP joints
-Squaring of the thumbs: Deformity of the carpometacarpal joint of the thumb resulting in fixed adduction of the thumb