Osteoarthritis Flashcards
What are some general risk factors of osteoarthritis?
Genetic factors
Overuse
Injury
What is the mechanism of osteoarthritis (simply)?
Imbalance between cartilage damage and the chondrocyte response leading to structural issues
What risk factors are there for osteoarthritis?
Obesity
Age
Occupation
Trauma
Female
Family history
What joints are commonly affected in osteoarthritis?
Hips
Knees
Distal interphalangeal
Carpometacarpal at the base of the thumb
Lumbar spine
Cervical spine (cervical spondylosis)
What key changes can be seen on x-ray in osteoarthritis?
Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts (fluid-filled holes in the bone)
Label the image
What is important to consider when taking x-rays with osteoarthritis?
X-ray may show degenerative findings but patient may be absolutely fine and vive.
How do patients with osteoarthritis present?
Joint pain and stiffness
When is joint pain and stiffness worse?
Worsens with activity
End of the day
How are presentations of osteoarthritis different from rheumatoid arthritis?
Osteoarthritis
Worse after activity and in the evening
Rheumatoid arthritis
Better after activity and worse in the morning
What signs of the joint indicate osteoarthritis?
Bony enlargement of the joint
Reduced range of motion
Crepitus on movement
Joint effusion
What are the signs of osteoarthritis in the hands?
- Heberden’s nodes (DIP)
- Bouchard’s nodes (PIP)
- Squaring (base of the thumb, CMC)
- Weak grip
- Reduced range of motion
What type of joint in the CMC at the base of the thumb?
Saddle joint
Why is the CMC joint at the base of the thumb prone to wear?
Gets a lot of use as its sits on the trapezium like a saddle and is constantly in contact
Why is it important to look at adjacent joints in osteoarthritis?
Referred pain
Patients can present with referred pain especially in adjacent joints
So if a patient has lower back or knee pain look at the hip
What are the NICE guidelines for osteoarthritis diagnosis?
Diagnosis can be made without investigation if patient is over 45 and has typical pain with activity and no morning stiffness (over 30 minutes)
What is the non-pharmacological management of osteoarthritis?
Patient education
Lifestyle changes
What are some examples of lifestyle changes which are recommended for osteoarthritis?
Therapeutic exercise - improve strength and function and reduce pain
Weight loss- reduces joint load
Occupational therapy- support activities and function e.g. walking stick
What is the pharmacological management of osteoarthritis?
Topical NSAIDs first-line for knee
Oral NSAIDs must prescribe a PPI
Why do you need to prescribe a PPI with long-term oral NSAID use?
Gastroprotection
Inhibits COX-1 resulting in reduced prostaglandins in the stomach so stomach acid is out of balance thus it must be reduced to not damage stomach mucosa
Are opioids used for osteoarthritis?
Weak opioids and paracetamol are only for short-term infrequent use
Do not use strong opioids
How long can intra-articular steroid injections be used for?
10 weeks
What oral NSAIDs are used for osteoarthritis or MSK pain?
Ibuprofen (first-line)
Naproxen
Why must oral NSAIDs be used cautiously in older patients?
More likely to be on anticoagulants such as:
- Aspirin
- DOACs (e.g. apiXaban -acts on factor Xa)
GI side effects of NSAIDs?
Gastritis
Peptic ulcers
Renal side effects of NSAIDs?
AKI e.g. acute tubular necrosis
CKD
Cardiovascular side effects of NSAIDs?
Hypertension
Heart failure
MI
Stroke
Respiratory side effects of NSAIDs?
Exacerbating asthma
Why are opioids not used with chronic pain?
Little evidence to suggest they help with chronic pain
Side effects such as tolerance, dependence and withdrawal
How do NSAIDs cause hypertension?
COX 1 inhibitor which results in reduced prostaglandin production
Prostaglandins cause vasodilation, reduced vasodilation results in increased blood pressure
