Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

Disorder of synovial joints which occurs when damage triggers repair processes leading to structural changes within a joint.

Question 2

Which joints are most typcialla affected by Osteoarthritis?

Answer 2

Knee

HIp

Small joint of Hands

(Shoulder, Spine)

Question 3

What are the main pathological features of OA?

Answer 3

• Localized loss of cartilage
• Remodelling of adjacent bone and the formation of osteophytes (new bone at joint margins).
• Mild synovitis (inflammation of the synovial membrane that lines the joint capsule).

Question 4

What is the epidemiology of OA

Answer 4

• Affects 25% of person aged >60
  
  • 70% radiological changes
• (Women>Men)
• More common in caucasians, asians

Question 5

What are risk factors for the development of OA?

Answer 5

• Genetic
• Female
• Increasing Age
• Obesity
• High and Low bone density

Joint

• stress, exercise, heavy loads
• damage, injury, reduced muscle strength, malingnacy

Question 6

What are presenting Symptoms of Osteoarthritis?

Answer 6

Activity-related joint pain

Without or with morning stiffnes/stiffnes after rest <30min

Functional impaimrnet

Question 7

What are signs of OA on exmaination?

Answer 7

• Crepitus on movement
• Hard swelling/Nodes
• Restricted Movement
• Joint effusions (uncommon except for the knee).
• Joint warmth and/or tenderness (there may be synovitis)
• Muscle wasting and weakness, joint instability

Question 8

What are investigations that should be done in OA?

Answer 8

Ask about impact on life

• Clinical diagnosis with exclusion of DD
• BMI

Question 9

What are the presenting signs and symptoms of OA in the Hand?

Answer 9

carpometacarpal (CMC) joint at the base of the thumb, the distal interphalangeal (DIP) joint, and the proximal interphalangeal (PIP) joint.

• wasting thenar muscles
• Osteophytes and subluxation –> squaring
• Heberden’s and Bouchard’s nodes

Question 10

What are signs and symptoms of OA in the hip?

Answer 10

Pain

• deep groin, radiating to thig, buttock, knee
• worse on activity (climbing stairs), can occur at rest (distrubling sleep)

Restriction of movement

• internal rotation with hip flexed
• Fixed flaxion on external rotation
  
  • with pelvic tilt and lumbar loidosis

Gait

• antalgig (lurge towards affected hip, less time spent)
• trendelenburg

Question 11

What are signs and symptoms of OA at the knee?

Answer 11

• Bilaterail symmetrical (if unilateral due too trauma/disease)
• Localised to affected compartment (Medial+lateral tibiofemorl/patellofemoral)
  
  • Medial: anteriomedial pain in walking
  • Lateral: lateralmedial pain when walking
  • Patellofemoral: anterior pain worse when stairs (going down) + prolonged sitting
• Giving Way
• Locking
• Crepituss
• Restriction of movement
• small - moderate effusion and synovitis

Question 12

What are X-Ray finding of OA?

Answer 12

• include subchondral bone thickening and/or cysts;
• osteophyte formation (new bone formation at joint margins)
• loss or narrowing of the joint space (provides an estimate of the severity of cartilage damage).

Question 13

Which investigations would you do in a patient with osteoarthritis?

Answer 13

• Clinical might be supported by
• X-ray of joint
  
  • Joint space narrowing
  • Loss of cartilage
  • Subchondral cyst
  • Subchondral sclerosis
  • Osteophytes
• Synovial FLuid analysis (to exclude differnetials)