Osteoarthritis Flashcards
What is osteoarthritis?
it is a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. Osteoarthritis can degrade cartilage at joints, change bone shape and cause inflammation, resulting in pain, stiffness and loss of mobility
Is osteoarthritis an autoimmune disease?
NO- it is a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life.
What does the extent of damage in osteoarthritis correlate to?
NOTHING- the extent of damage does NOT correlate to the extent of pain the patient feels.
Which patient groups are more likely to be diagnosed with osteoarthritis?
- More common in women
- Risk increases with age- most diagnosed over the age of 45 years
- Thought 8.75 million people in the UK aged 45+ have seen a doctor about osteoarthritis
- 1/3 of women and 1/4 of men between 45 and 64 years of age have sought treatment for osteoarthritis. This rises to almost half of people aged 75 years+
Where is the most common site for people to first be affected by osteoarthritis?
knees
What are the co-morbidities associated with osteoarthritis?
- Increased CV risk - increase by 17% in women and 15% in men
- Depression- 20% of people with osteoarthritis experience depression
What is the difference between primary and secondary osteoarthritis?
Primary osteoarthritis has no known cause. Secondary osteoarthritis is caused by another disease, infection, injury, or deformity.
What are the risk factors for developing osteoarthritis?
- Age- being 45+ due to a decrease in growth hormones and decrease in muscle strength
- Gender- female- due to decrease in oestrogen
- Obesity- BMI >25 (2.5-4.6 x more likely to to develop knee arthritis)
- Occupation- e.g. if physically demanding
- Genetics- estimated heritability of 40-65% depending on joint site
What are the symptoms of osteoarthritis?
- Joint pain and tenderness- worsens with activity
- Joint stiffness
- Swelling, redness
- Grating/crackling sound or sensation when moving joints
- Morning stiffness- doesn’t exceed 30 mins
- Muscle wasting
- Nodes on hands or fingers/ appearing nobbly
- can affect any joint in the body, but the most common areas affected are the knees, hips and small joints in the hands
When does NICE recommend a diagnosis without the need for clinical investigations?
- Activity-related joint pain
- Morning stiffness that doesn’t exceed 30 minutes
- Over 45 years old
Blood tests and x-rays may be used but are not usually necessary
What are the treatments recommended for osteoarthritis?
LIFESTYLE CHANGES:
- Weight loss
- Exercise- the CORE treatment- needs both muscle strengthening and aerobic exercise
- Physical aids- footwear that’s shock-absorbing, braces, splints, walkers, sticks, grippers
PHARMACOLOGICAL TREATMENT: none of this is to cure, but is a symptomatic relief
- Pain relief- should be in combination with lifestyle changes
e.g.
Topical NSAIDs- 4-week trial
Paracetamol
Topical Capsaicin cream 0.025%- Apply up to QDS at regular intervals
Oral NSAIDs + PPI for GI protection
Opioids if can’t tolerate NSAIDs or on low-dose aspirin already (caution in elderly
intr-articular corticosteroids- injected directly into the joint
ALSO
Thermotherapy
TENS machine
Surgery- if severe- joint replacements e.g. knees or hips
What gender is more common for OA diagnosis?
female
What age is more common for OA diagnosis?
Over 45 years
What is the core treatment for OA?
INCREASED EXERCISE!
Should be a mix of both muscle strengthening and aerobic exercise
What is the first-line pharmacological treatment for osteoarthritis?
Topical NSAID
Then oral NSAID, if topical inadequate
Paracetamol or opioids aren’t routinely offered according to NICE
