Osteoarthritis Flashcards
What is osteoarthritis?
A non-inflammatory degenerative joint disorder characterised by joint pain and functional limitation
What joints are typically affected by osteoarthritis?
Knees
Hips
Hands - distal interphalangeal (DIP) and carpometacarpal (CMC)
Cervical and lumbar spine
What are the risk factors for osteoarthritis?
Family history
Increasing age
Female
High bone density
Obesity
Joint injury
Exercise stresses
What is the clinical presentation of osteoarhritis?
Joint pain
Pain exacerbated by movement and relieved by rest
Joint stiffness
Little morning stiffness (<30 minutes)
Joint locking
What signs in the hand may be seen in a patient with osteoarthritis?
Heberden’s nodes
Bouchard’s nodes
Thenar muscle wasting
Squaring at the base of the thumb
Weak grip
Reduced range of motion
What findings will be seen on X-ray in a patient with osteoarthritis?
Loss of joint space
Osteophytes
Subarticular sclerosis (increased density along the joint line)
Subchondral cysts
What is the diagnosis of osteoarthritis?
Can usually be made clinically if the patient is above 45 and has typical pain associated with activity, and no morning stiffness
What investigations can be useful in the diagnosis of osteoarthritis?
Joint XR
ESR and CRP - differentiate between OA and RA
WBC - exclude septic arthritis
Rheumatoid factor and anti-CCP
What is the non-pharmacological management of osteoarthritis?
Therapeutic exercise
Weight loss
Occupational therapy
Physiotherapy
What is the first line medical management of osteoarthritis?
Simple analgesia - paracetamol and topical NSAIDs
What is the second line medical management of osteoarthritis?
Oral NSAIDs (with PPI cover)
Weak opioids - codeine
Topical capsaicin
Intra-articular steroids
What are the complications of osteoarthritis?
Joint effusion
NSAID related complications - nephrotoxicity, GI bleeding
Low mood
Chronic pain
Functional decline
Reduction in ADLs
Falls
