Osteoarthritis

Question 1

Osteoarthritis presentation

Answer 1

• gradual onset, activity-related pain
• joint stiffness with inactivity
• joint swelling, effusion, bony enlargement
• deformity - varus/valgus, Bouchard’s, Heberden’s
• limited range of motion
• functional impairment

Question 2

Osteoarthritis investigations

Answer 2

• X-ray shows:
• Loss of joint space
• Osteophyte formation
• Subchondral cysts
• Subchondral sclerosis
• no need for investigations if patient over 45 with exercise-related pain and morning stiffness under 30 minutes

Question 3

Osteoarthritis differentials

Answer 3

• rheumatoid arthritis
• fracture
• malignancy
• ligament tear (in knee)
• bursitis, AVN (in hip)
• De Quervain’s (in hand)

Question 4

Osteoarthritis management

Answer 4

• education, exercise, weight loss
• NSAIDs > paracetamol + topical analgesia > NSAID + paracetamol + topical capsaicin > opioid + NSAID + paracetamol + topical capsaicin
• acute exacerbation - steroid injection
• joint replacement