Osteoarthritis

Question 2

What is osteoarthritis?

Answer 2

A chronic, degenerative, and progressive condition affecting synovial joints. Metabolically dynamic process, not just wear and tear.

Osteoarthritis is not merely ‘wear and tear’ but a metabolically dynamic process.

Question 3

What causes osteoarthritis?

Answer 3

Occurs when abnormal loads are placed on a normal joint or normal loads are placed on an abnormal joint

This can lead to conditions such as tibial plateau fractures and ACL reconstruction.

Question 4

What are the main characteristics of osteoarthritis?

Answer 4

Characterized by pain, limited range of motion (ROM), and possible deformity

These symptoms can vary in intensity among individuals.

Question 5

What is spondylosis?

Answer 5

Osteoarthritis of the synovial joints of the spine (facet)

It is a common spinal disorder that can be discussed in detail in a specific lecture.

Question 6

Fill in the blank: Osteoarthritis is a _______ condition affecting synovial joints.

Answer 6

chronic

Question 7

True or False: Osteoarthritis is solely caused by wear and tear.

Answer 7

False

Question 8

What type of joint is primarily affected by osteoarthritis?

Answer 8

Synovial joints

These joints include various types such as hinge joints, ball-and-socket joints, etc.

Question 9

What percentage of people over 55 have OA?

Answer 9

44-70%

Question 10

What % of people >75 have OA

Answer 10

85%

Question 11

What is OA associated with?

Answer 11

Associated with increased age / weight

Question 12

Rank the joints that are most commonly associated with OA

Answer 12

Knee> Hip> Hand (DIPJ and CMC)

Question 13

What type of pain is common with OA?

Answer 13

multisite pain is common
(hips, knees, hands, feet): 60-80%
reported

Question 14

What are the biochemical changes associated with OA

Answer 14

Articular cartilage = water +collagen +proteoglycans
◼ Loss of proteoglycan relative to collagen
◼ Decrease in water content and permeability
◼ Reduction in collagen tensile stiffness and strength
◼ Proteolytic enzymes-Matrix mettalloproteases (MMPs).
◼ Pro-inflammatory cytokines; TNF, IL-1β(some inflammatory
component)

Question 15

What is the pathology of OA

Answer 15

Failed attempt at Repair

Question 16

Six stages of OA?

Answer 16

1.Hyaline cartilage
Fibrillation in
superficial layers
→ deeper layers

2.Joint Space
Narrowing

3.Bony sclerosis

4.Excessive shear
at the joint space

5.↑osteoblast
activity as
attempt to
redistribute load

6.Osteophyte
formation

Question 17

Modifiable Risk Factors for OA

Answer 17

◼ Obesity (knee>hip)
◼ Occupational /Heavy
work
◼ Squatting, kneeling, heavy
lifting
◼ Excess physical activity/
e.g. professional soccer
players, high-impact sports

Question 18

Unmodifiable Risk Factors for OA

Answer 18

◼ Age
◼ Genetics 40-80%
◼ Local bony changes
◼ e.g. Hip cam deformity, hip
dysplasia
◼ Previous joint trauma
◼ E.g intra-articular fracture,
ACL injury

Question 19

OA is classified into which two types?

Answer 19

Primary and Secondary OA

Question 20

Characteristics of primary OA?

Answer 20

◼ Idiopathic
◼ Spontaneous onset
◼ Small joints hand, hip
and knee
◼ May affect >1 joint
◼ Strong link with genetics

Question 21

Characteristics of secondary OA?

Answer 21

◼ Often specific to one
joint
◼ Post- inflammatory
arthritis e.g. RA
◼ Post –traumatic (e.g.
fracture tibial plateau)
◼ Post-traumatic OA (e.g.
post ACL repair)

Question 22

Clinical Diagnosis of OA

Answer 22

◼ Joint pain
◼ Stiffness ( lasting < 30mins am or
prolonged rest)
◼ +/- crepitus on movement
◼ Bony enlargement
◼ Little or no swelling

Question 23

Radiological Diagnosis of OA

Answer 23

◼ Joint space narrowing
◼ +/-Osteophyte
formation
◼ +/- Bony sclerosis

Question 24

What is recommended regarding clinical diagnosis of OA

Answer 24

Clinical Diagnosis can be
made without imaging and
is recommended to not perform imaging for those with typical presentation of OA

Question 25

Correlation between x-ray severity and joint pain?

Answer 25

poor

Question 26

What type of ESR and CRP levels are associated with OA

Answer 26

Usually normal, only appropriate to differentially diagnose from inflammatory arthritis

Question 27

Types of imaging that can diagnose OA

Answer 27

◼ X-ray ◼ MRI ◼ US (useful for detecting effusion) ◼ MRI and US better at detecting early signs not detected by plain x-ray

Question 28

What are the NICE guidelines 2022: Diagnosis of OA

Answer 28

◼ Diagnose osteoarthritis clinically without investigations in people who: ◼ are 45 or over have activity-related joint pain and ◼ have either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes. ◼ Do not routinely use imaging to diagnose osteoarthritis unless there are atypical features or features that suggest an alternative or additional diagnosis

Question 29

What are some differential diagnosis of OA

Answer 29

◼ Inflammatory Arthritis ◼ Other intra-articular joint disorders ◼ E.g. hip: labral tear /FAIS ◼ Knee: degenerative meniscal injury ◼ Consider pain referred from other joints ◼ E.g. Knee pain referred from hip ◼ Hip pain referred from lumbar spine

Question 30

Which joints in the hand is OA most associated with?

Answer 30

Most common in PIP, DIPs and Thumb CMC

Question 31

How are co-morbidities associated with symptoms of OA

Answer 31

◼ Having at least one co-morbidity significantly associated with worse, or greater deterioration, of symptoms of pain and physical function (Calders et al, 2018)