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Clinical lectures: Yr1 > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

epidemiology, pathophysiology, presentation, investigation, management and prognosis

1
Q

Is the onset of OA gradual or rapid, and from what age does OA onset begin?

A

Gradual onset from age 40

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2
Q

Between what ages does OA incidence increase rapidly?

A

50-75

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3
Q

What percentage of individuals with OA have limited mobility?

A

80%

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4
Q

What percentage of individuals with OA have difficulty performing daily lifestyle activities?

A

25%

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5
Q

Is prevalence and risk of OA higher in men or women?

A

Women

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6
Q

How does change in composition of the articular cartilage due to OA affect it’s susceptibility to physical forces?

A

Becomes more susceptible to disruption by physical forces, which is why mechanical stress causes joint degeneration

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7
Q

How much of a joint does OA degenerate?

A

Entire joint

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8
Q

What cells cause articular cartilage to degrade and reveal underlying bone in OA, and what do they release to cause degradation?

A

Chondrocytes in areas of stress, that proliferate and release inflammatory mediators that degrade cartilage matrix

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9
Q

After the articular cartilage degrades and underlying subchondral bone is revealed in OA, how does new articular cartilage form?

A

Underlying subchondral bone becomes the new articular cartilage

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10
Q

In the process of articular cartilage degeneration and underlying subchondral bone becoming the new articular cartilage, how does this affect the joint space in OA?

A

Causes joint space narrowing

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11
Q

How does subchondral sclerosis occur in OA?

A

Mechanical stress on underlying subchondral bone (that has become new articular cartilage) grows and hardens

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12
Q

How do osteophytes form from the new articular cartilage in OA?

A

Local bony areas grow into outgrowths/protrusions

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13
Q

What factors are released in OA that result in pain and inflammation, and how do the factors stimulate this?

A

Vascular growth factors stimulate neurovascular development, which causes pain and inflammation in the joint

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14
Q

How do bone cysts form in OA?

A

They form in areas of localised bone necrosis and resorption, which occurs due to stress-induced microfractures in subchondral bone

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15
Q

What is subchondral bone?

A

Bone beneath articular hyaline cartilage

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16
Q

How does OA affect the synovial lining, and what is the name of this condition?

A

Synovitis: inflammation and thickening of synovial lining

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17
Q

What is the name of swelling that occurs in OA?

A

Joint effusion

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18
Q

What is the difference between primary OA and secondary OA?

A

Primary OA arises from non-specific/idiopathic cause

Secondary OA arises from another specific cause

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19
Q

Give 3 examples of causes that can lead to secondary OA onset?

A

Trauma, RA, infection

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20
Q

Does OA present in the same way in every joint?

A

No, presentation of OA depends on type of affected joint

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21
Q

What aspect of the knee is affected by OA, and what is the resulting deformity?

A

Affects weight-bearing inner aspect which narrows joint space, so results in varus deformity, characterised by bow-legged look

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22
Q

When does pain occur due to knee OA, and how does it change throughout the day?

A

Activity-related pain that is worst at night and is relieved by morning due to rest

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23
Q

Is elbow OA common in primary or secondary OA?

A

No, it is rare

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24
Q

What 4 movements are painful due to elbow OA?

A

Elbow flexion, extension, supination, pronation

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25
Q

What 3 places can pain arise in due to hip OA?

A

Thigh, buttocks, groin

26
Q

What 2 activities are difficult due to hip OA?

A

Walking up and down stairs

Putting on shoes

27
Q

What are 2 characteristic features of hand OA?

A

Heberden’s nodes form when osteophytes grow at distal interphalangeal joints

Base of thumb is square-shaped

28
Q

What condition can severe development of shoulder OA lead to, that affects the shoulder joint stability and movement?

A

Rotator cuff tear arthropathy, due to OA causing loss of function in rotator cuff

29
Q

What are the 2 ways in which rotator cuff tear arthropathy is managed?

A

Total anatomical replacement of rotator cuff

Reverse anatomical replacement, so that deltoid moves and positions arm instead

30
Q

Why do OA patients commonly present with disuse atrophy?

A

Pain has gradual onset and is worsened by movement, so patients avoid movement which causes muscle wasting

31
Q

What 4 X-ray features indicate OA?

A

Osteophytes
subchondral cysts
narrowed joint space
subchondral sclerosis

32
Q

Is a blood test necessary to diagnose OA?

A

No, but is useful to exclude differential diagnoses eg. RA, PsA, gout

33
Q

What is the focus of OA management?

A

Changing lifestyle

34
Q

Why is a long-term physiotherapy plan and exercise implemented for OA management?

A

To maintain physical function and decrease further degeneration

35
Q

What 2 types of exercise must be included in physiotherapy for OA management?

A

Local muscle strengthening

General aerobic exercise

36
Q

What shoes are beneficial for individuals with knee and hip OA?

A

Shoes with thick, shock-absorbing soles and no raised heels

37
Q

Give 3 examples of physical aids that are useful to individuals with hip and knee OA?

A

Walking sticks

Walking frames

Wheeled walkers

38
Q

Why is occupational therapy useful for individuals with OA?

A

They add home modifications that can make it easier for individuals to complete daily activities despite limited mobility eg. handrails on stairs

39
Q

Why are medicines used in OA management?

A

Adjunct (supplementary) alongside core physical management, used for symptomatic relief eg. pain, inflammation

40
Q

What are the 2 first-line therapies for OA management?

A

Topical NSAIDs

Paracetamol monotherapy

41
Q

If topical NSAIDs and/or paracetamol provide insufficient/no symptomatic relief for OA, what medication can be used?

A

Oral NSAIDs, which can be used in combination with paracetamol

42
Q

If oral NSAIDs are contraindicated in OA management, what medication can be used?

A

Opioid analgesics, which can be used in combination with paracetamol

43
Q

What medication is beneficial for providing symptomatic relief in hand and knee OA, and when can it be used?

A

Topical capsaicin can be used in any stage of treatment

44
Q

Why are intra-articular corticosteroid injections provided in OA?

A

Moderate-severe pain relief caused by inflammation and swelling

45
Q

When is orthopaedic surgery required in OA management?

A

Severe joint deterioration, and before there is prolonged and established functional limitation and severe pain

46
Q

Are patient-specific factors such as gender, smoking, obesity barriers to referral for orthopaedic surgery?

A

No

47
Q

What are the 3 requirements to clinically diagnose OA with no other investigations, according to NICE guidelines?

A

45y or over

Activity-related joint pain

Either no morning joint-related stiffness, or morning stiffness that lasts no longer than 30 minutes

48
Q

If an obese/overweight person has OA, what intervention is recommended by NICE?

A

Intervention to encourage weight loss

49
Q

What is arthrodesis surgery?

A

Any diseased cartilage between two bones is removed and the bone ends are cut off, and connected to another using metal internal fixation, such as screws and plates, then eventually grow into one another and fuse to become one bone

50
Q

What are 2 benefits of arthrodesis?

A

Durable, provides pain relief

51
Q

What is the disadvantage of arthrodesis?

A

Need to sacrifice some movement

52
Q

What is the main difference between arthrodesis and arthroplasty?

A

Arthrodesis causes fusion within the joint

Arthroplasty causes replacement within the joint

53
Q

Give 3 examples of types of arthroplastys?

A

Excision arthroplasty

Hemiarthroplasty (replacing half of hip/only femoral head)

Total joint arthroplasty (replaces all parts of joint/eg. Femoral head and acetabulum)

54
Q

Give 1 benefit and disadvantage of an arthroplasty?

A

Keep range of movement

Not durable and wears over time

55
Q

What is a trapeziectomy?

A

Form of excision arthroplasty where trapezium bone at base of thumb is removed, treats thumb base OA and squaring

56
Q

Give 2 benefits and disadvantages of a trapeziectomy?

A

Durable and preserves range of movement

Can cause carpal instability and has long rehab period

57
Q

What is the main factor in deciding whether you should fuse or replace a joint?

A

The range of motor function in that joint eg. in a joint that is used for a lot of flexion should be replaced

58
Q

Give immediate, early and late complications of an arthroplasty?

A

Immediate: technical eg. perioperative fracture

Early: infection, dislocation (could be constrained or unconstrained)

Late: aseptic loosening (bone implant interface), wearing over time

59
Q

Give 2 functions for regular reviews of individuals with symptomatic OA?

A

Monitor long-term course of OA

Review effectiveness and tolerability of treatments for OA

60
Q

What are the 3 conditions that if an individual has one or more, they have annual reviews of their OA?

A

Other illnesses or conditions

Troublesome joint pain, more than one joint affected

Taking any drugs for their osteoarthritis

Clinical lectures: Yr1 (28 decks)

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