Osteoarthritis Flashcards
What is osteoarthritis?
A degenerative disease affecting synovial joints and the articular cartilage. It is associated with ageing and will most likely affect the joints that have been continuously stressed throughout the years including the knees, hips, fingers and lower spine region
Who is more likely to develop osteoarthritis and what in the body does it effect?
Prevalence increases with age
Age of onset is usually over 60 years.
More common in females.
More common if BMI >30 (obese)
Most common in knees, but can affect hips and hand/wrists.
Is asymmetrical and tends to affect synovial joints.
What are the risk factors?
Biological
Increasing age
Female sex
Obesity
Biomechanical
Previous injury
Previous disease such as rheumatoid arthritis or gout
Genetic
Genetic predisposition
What are the symptoms and characteristics?
Main symptoms are pain and stiffness.
Poor sleep
Anxiety / Depression
Social isolation
Loss of work
Reduced quality of life
What joints are effected?
Synovial joints
What happens to the synovial joints in OA?
OA occurs when the cartilage layer covering the joint is degraded.
The exposure of underlying subchondral bone results in sclerosis.
Reactive remodeling changes then occur that lead to the formation of osteophytes and subchondral bone cysts.
The joint space is progressively lost over time.
How is OA diagnosed?
OA is diagnosed clinically without investigations if a person:
Is 45 years or older and
Has activity-related joint pain and
Has either no morning-related joint stiffness or morning stiffness that lasts no longer than 30 minutes
On examination
Bony swelling and joint deformity.
Joint effusion
Joint warmth and/or tenderness
Muscle wasting and weakness.
Restricted joint movement, crepitus
Joint instability.
What are the goals of therapy?
No cure – treatment aims to improve symptoms.
Relieve pain.
Increase mobility.
Decrease disability.
Improve quality of life.
What is the core treatment?
Exercise
Weight management
Pain control
Non-pharmacological
Pharmacological
Information and support
Websites www.versusarthritis.org and https://www.nhs.uk/conditions/osteoarthritis/
What is the non pharmacological treatment?
Therapeutic exercise (physiotherapy)
Weight loss
Wearing suitable footwear
Promoting good posture
Use of special aids or devices to reduce the strain on your joints during your everyday activities
All people with osteoarthritis should be offered therapeutic exercise tailored to their needs (for example, local muscle strengthening, general aerobic fitness). with reassurance that exercise, e.g., resistance training, tai chi, yoga, and water-based exercise, is not harmful to the joints). Support from a physiotherapist in a supervised exercise sessions may be available to advise on muscle strengthening and aerobic fitness training, which may also protect joints. Patient should be made aware that joint pain may increase when they start therapeutic exercise. But, undertaking regular exercise, even though it initially cause pain or discomfort, will be beneficial for their joints. Long-term adherence to an exercise plan increases its benefits by reducing pain and increasing function and quality of life.
Recommend weight loss, if the person is overweight or obese – what strategies would be helpful for this? See if students suggest gen healthly diet information.
Good footwear reduces the risk of falls, can help keep joints in alignment where tendons are loose and risk of joint mobility.
Pain often makes people with OA in the knee favour one side over the other so good posture can be important to reduce additional wear and tear on other non-affected joints and as a strategy to reduce the pain and the risk of the joint giving way.
Around half of those with symptomatic OA use supportive aids, such as walking sticks, frames and support garments. Fewer than half of these aids are obtained by prescription, meaning there is the potential for incorrect sizing and unsafe technique. Walking aids and altered gait are two of the biggest risk factors for falls, so it is important that people who use walking aids are given the appropriate advice from physiotherapists
What is the pharmacological management?
1st - Topical analgesia – NSAID
Diclofenac 1% 3-4 x daily
2nd - Oral NSAID: naproxen 250mg – 500mg 2 x day
If not tolerated - paracetamol
3rd - Intra-articular injections
Corticosteroid: e.g methylprednisolone
What is the 1st line of treatment?
Non-steroidal anti-inflammatory drugs:
Topical: diclofenac, ibuprofen, piroxicam
Oral: Non-selective - ibuprofen, naproxen, diclofenac….
Cox-2 selective - celecoxib. etoricoxib.
Different NSAIDs differ in potency, duration of action, side effects, and formulation.
What is the 2nd line in treatment?
How do NSAIDs work?
Mode of action:
Most act as non-selective inhibitors of cyclooxygenase, inhibiting both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) isoenzymes.
COX-1 is present in most of the tissues in our bodies. In the GI tract, COX-1 maintains the normal lining of the stomach and intestines, protecting the stomach from the digestive juices.
COX-2 is primarily found at sites of inflammation.
Both COX-1 and COX-2 produce the prostaglandins that contribute to pain, fever, and inflammation, but since COX-1’s primary role is to protect the stomach and intestines and contribute to blood clotting, using drugs that inhibit it can lead to unwanted side effects.
What is the third line?
COX-2 inhibitors (‘coxibs’):
NSAIDs that directly target COX-2, reducing the risk of peptic ulceration.
Higher risk of cardiovascular adverse effects due to inhibition of COX-2 in blood vessels, leading to a decrease of production of prostacyclin which may cause clot formation and hypertension.
Balance cardiovascular vs. GI risk.
