Osteoarthritis

Question 1

What is arthritis?

Answer 1

Arthritis is when there is joint inflammation, including swelling, deformity and pain. This can occur in single or multiple joints.

Most types of arthritis are long term conditions and there are multiple different causes including autoimmune responses.

Question 2

What is the synovial joint and why is it usually affected by arthritis?

Answer 2

The synovial joint is the most common and most moveable joint in the body.

The skeleton is held apart by this cavity.

The joint is surrounded by a capsule filled with thick fluid, synovial fluid, that helps to lubricate the joint. So these capsules help to hold the joints in place and they do that by the help of all the ligament, muscles etc.

The ends of the bones within the joint are lined by cartilage which is smooth but tough layer of tissue that allows bones to grow and move without friction.

Question 3

What is osteoarthritis?

Answer 3

Osteoarthritis is the most common form of Arthritis.

Osteoarthritis is NOT an autoimmune disease.

Defined as (NICE) :
“A clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life”

It is disorder of the joints caused by loss of articular cartilage and followed by response in the body to try and repair the damage which can in turn make things worse and cause damage to the periarticular bone.

Osteoarthritis can affect any synovial joint, but most commonly affects the knee, hips, spine and small joints in the hands and fingers.

The extent of the damage does not correlate to the extend of the pain the patient might feel.
- An x-ray could show minimal damage but the patient reports strong feelings of pain and vice versa.

Can be found in weight bearing and non-weight bearing joints.

Question 4

What impact does Osteoarthritis have on the patients life?

Answer 4

Co-morbidities:
- Patients have a high risk of being hospitalised for cardiovascular disease.

• Experience symptoms of anxiety and depression (due to pain their feeling, worries about going and doing daily activities)

Quality of life:
- Pain (constant pain - often described as unbearable)

• Work (retire early or reduce work hours due to pain)

Question 5

What is the pathophysiology of Osteoarthritis? (what is happening in the body)

Answer 5

• In osteoarthritis the whole joint is involved.
• Due to trauma or other unknown factors theres damage to the cartilage
• The rate of damage then begins to exceed the rate of repair which leads to the degeneration of the bone and cartilage.
• When the cartilage cells are injured this sets off an inflammatory response and production of the pro inflammatory mediators.
• As the cartilage is damaged, more of the joint fails to dissipate the joint ‘load’ effectively, which then causes further damage to the whole joint.
• Eventually the actual bone becomes exposed more and more, attempts by the body to repair the bone causes cartilaginous growth at the edge of the joint which can become calcified causing osteophytes (bony spurs/lumps).
• The continuity of the pro-inflammatory mediators and the catabolic enzymes can ultimately lead to complete cartilage destruction.
• The underlying bone will have a polished smooth appearance or eburnation which is an unusual ivory like harness, in areas where theres direct contact with another bone.
• This all results in the narrowing of the joint space causing synovitis (which is painful and tender inflammation of the synovial lining of the joint) and effusion (which is swelling of the joint)

Question 6

What are the risk factors and causes of osteoarthritis?

Answer 6

Osteoarthritis can be primary or secondary.

Primary - Idiopathic (exact cause if unknown and theres damage to the cartilage)

Secondary - Specific cause
- So theres previous injury to joint, congenital abnormality or inflammatory arthritis

Risk factors:
1. Age (45+) :
“wear and tear”/ reduction in growth hormones to repair is slower / reduction in muscle strength hence less support for the joint

2. Gender (female):
   Due to drop of oestrogen levels at menopause
3. Obesity (BMI >25):
   Extra weight and pressure on the joints causing damage.
4. Occupation:
   Physically demanding

Genetics:
- There is an estimated heritability of 40-65% depending on joint site.

Question 7

How is osteoarthritis diagnosed?

Answer 7

Signs and symptoms:

• Activity related joint pain
• Morning stiffness lasts no longer than 30 minutes
• Muscle wasting
• Hand/fingers often presents as ‘nodes’

Diagnosed clinical without investigations (NICE)

• Activity related joint pain AND
• Morning stiffness lasts no longer than 30 minutes (OR no morning stiffness) AND
• Over 45 years

X-rays and blood tests may help to aid diagnosis

Question 8

What management can be done for Osteoarthritis?

Answer 8

1. Holistic approach (consider the patient as a whole, hobbies, sleep, work, diet etc.)
2. Lifestyle changes:
   - Weight loss
   - Exercise (CORE- FIRST LINE)
   - Physical aids (support)
3. Pharmacological treatments mostly involve pain relief:
   - Topical NSAIDs or Topical capsaicin
   - Paracetamol
   - Oral NSAIDs (+PPI)
   - Opioids (elderly - need to be cautious)
   - Intra-articular corticosteroids (injections)
4. Others
   - Thermotherapy (Hot and cold)
   - Electrical nerve stimulation
   - NO HEAT CREAM - TOPICAL
   - Supplements
5. Surgery - SEVERE
   - Joint replacements (e.g. Hip replacements