osteoarthritis Flashcards
what is the pathophysiology of OA?
continuous trauma to joints causes local inflammation -chondrocytes stimulated to make degradative enzymes -articular cartilage gets destroyed.
osteophytes»_space; osteocytes
cartilage things over time leading to exposure of underlying bone.
RFs of OA?
↑age
female sex
FH
↑ or ↓ bone density
↑strain on joints-obesity, strenuous job, injury eg fractures, ligament damage
coinciding joint damage eg RA
example of disease that increases bone density?
paget’s disease of bone
most common joints affected by OA?
hip, knee, spine, wrist
symptoms of OA?
joint pain: worse on movement, weight bearing, end of day
joint stiffness <30min in morning
reduced joint function
instability of joint
signs of OA?
periarticular tenderness
crepitus
decreased ROM
muscle wasting
joint deformity/instability
squaring of thumb
bouchard’s nodes
heberden’s nodes
what bloods would you do for ?OA and their results?
FBC, CRP, ESR, RF, anti-CCP -usually all normal
what does OA x ray show?
LOSS:
loss of joint space
osteophytes
subchondral cysts
subchondral sclerosis
what does OA MRI show?
can show early thinning of cartilage
what does OA arthroscopy show?
cartilage loss and erosion
what does OA joint aspiration show?
sterile viscous fluid and WCC may be slightly elevated
which beyond investigations would you do for ?OA?
XR
MRI
arthroscopy
joint aspiration
non pharmacological management of OA?
education and advice
exercise -non weight bearing eg swimming
weight loss if needed
aids and devices
TENS for pain relief
what does TENS stand for?
transcutaneous electric nerve stimulation
what is the stepwise treatment for OA?
1)paracetamol
1) topical NSAIDs
1) topical capsaicin
2) oral NSAID +PPI
3) cocodamol (can skip this step)
4) weak opiod eg codeine
5) intra-articular corticosteroid injections (do before giving any stronger opioids than codeine)
