Osteoarthritis

Question 1

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Ostearthritis : Pathophysiology

Answer 1

Osteoarthritis is thought to result from an imbalance between ;
* Cartilage damage and thechondrocyte response
* Leading to structural issues in the joint.

Question 2

Ostearthritis : Commonly affected joints

Answer 2

1. Hips } second most common
2. Knees } most common
3. Small joints
4. Distal interphalangeal (DIP) joints in the hands
   * Herbenden’s /Bouchard nodes
   5 . Carpometacarpal (CMC) joint at the base of the thumb
   * Squaring at the base of the thumb
   6 . Spine
   * Lumbar spine
   * Cervical spine - cervical spondylosis

Question 3

Ostearthritis : X-ray changes

Answer 3

“LOSS” mnemonic:
1 .L – Loss of joint space due to loss of articular cartage
2 . O – Osteophytes (bone spurs), formed by osteoblasts remodelling to help stabilise joint in response to losing cartilage
3 . S – S ubarticular sclerosis
* increased density of the bone along the joint line as subchondral bone above the cartilage undergoes remodelling

• Increase in osteoblast active results in denser bone forming - increases joint stiffness

4 . S– *S ubchondral cysts (fluid-filled holes in the bone)
* micro fractures caused by stress, synovial fluid can leak and accumulate into these areas

Question 4

Osteoarthritis : Clinical features;

Answer 4

1. Joint pain and stiffness
   * Worsens with activity } minimal morning stiffness, worse at the end of the day
   * OA of hip : Groin ache following exercise, relieved by stress

Question 5

Osteoarthritis: Clinical Signs

Answer 5

1. Bulky, bony enlargement of the joint } No joint swelling
   In response to articular degeneration, increase osteoblast activity to stabilise the joint
   * Heberden’s nodes (in the DIP joints)
   * Bouchard’s nodes (in the PIP joints)
   * Squaring at the base of the thumb (CMC joint)
2. Restricted range of motion
3. Crepitus on movement
4. Effusions (fluid) around the joint

Question 6

Osteoarthritis : Diagnosis

Answer 6

NICE recommend that we can diagnose osteoarthritis clinically without the need for investigations if:
1. Patient is > 45 years
2. has exercise related pain
3. No morning stiffness or morning stiffness lasting > 30 minutes

Question 7

Osteoarthritis : Management

Answer 7

1. Life style advice : exercise, weight loss,
2. Pharmacological
   First line : Topical NSAID
   Second line : Oral NSAID with PPI
3. Intra-articular steroid injection (short term relief 2-10 weeks

Cocodamol/Tramadol : used for short term pain relief
* Avoid paracetamol and opioids - minimal effect in chronic pain