Osteoarthritis Flashcards
What is osteoarthritis?
wear and tear of the synovial joints due to an imbalance between cartilage damage and chondrocyte response, leading to structural issues in the joint
Give 6 risk factors for osteoarthritis:
1) age
2) obesity
3) occupation
4) trauma
5) female sex
6) family history
Give 5 joints commonly affected by osteoarthritis:
1) hips
2) knees
3) distal interphalangeal joints of the hand
4) carpometacarpal joints of the thumb
5) lumbar and cervical spine
Give the 4 LOSS X-ray changes seen in osteoarthritis:
1) loss of joint space
2) osteophytes (bony lumps - extra bone formation)
3) subarticular sclerosis (increased bone density of the joint plate)
4) subchondral cysts (fluid filled holes in the bone)
Describe the presentation of osteoarthritis:
joint pain and stiffness which tends to worsen with activity and at the end of the day
Give 5 signs of osteoarthritis:
1) crepitus
2) effusion around the joint
3) Heberden’s nodes (DIP joint)
4) Bouchard’s nodes (PIP joint)
5) squaring at the base of the thumb (carpometacarpal joint)
At which joint would you find Heberden’s nodes in OA?
DIP
At which joint would you find Bouchard’s nodes in OA?
PIP
True or false: patients with OA may present with referred pain in nearby joints
True
Give 3 non-pharmacological management strategies for OA:
1) therapeutic exercises and physio
2) weight loss (to reduce load on the joint)
3) occupational therapy
Give 2 pharmacological management strategies for OA:
1) topical NSAIDs
2) oral NSAIDs
What is prescribed alongside long term oral NSAIDs?
PPI (for gastroprotection)
True or false: weak opiates and paracetamol are recommended for long term OA treatment
False
Give 2 invasive management strategies for OA:
1) intra-articular steroid injection
2) joint replacement
Give 4 side effects of long term NSAID use:
1) gastritis and peptic ulcers
2) AKI and CKD
3) hypertension
4) exacerbating asthma
How can NSAIDs cause hypertension?
they block prostaglandins which cause vasodilation
What are the 5 signs found in the hands?
Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb (CMC joint)
Weak grip
Reduced range of motion
Where does OA most commonly present?
Knee joint
What is a common feature seen in OA of the hip?
chronic history of groin ache following exercise and relieved by rest
What features in a history may suggest that there is an alternative cause of pain in the hip?
- Pain at rest
- Pain at night
- Morning stiffness for more than 2 hours
How is OA of the hip investigated?
NICE recommends that if the features are typical then a clinical diagnosis can be made
otherwise plain x-rays are the first-line investigation
What criteria needs to be met if we are to clinically diagnose OA?
- Patient is older than 45
- Patient has exercise related pain
- No morning stiffness or no morning stiffness lasting > 30 minutes
What is found on an examination of the knee if the patient has OA of the Knee joint?
- Knee pain: this is exacerbated when walking up inclines or when standing from a sitting position
- Varus deformity (valgus deformity is rare with knee OA)
- Joint line tenderness
- Joint line bony swelling (osteophytes)
- Crepitus
- Quadricep wasting due to reduced muscle activity
- Fixed flexion deformities
What are 6 features of OA of the hand?
- Usually bilateral
- Episodic joint pain
- Stiffness
- Painless nodes (heberden’s at DIPJ, Bouchard’s at PIPJ)
- Squaring of the carpometacarpal joint of the thumb
- May be reduced grip strength
