Osteoarthritis Flashcards
What is osteoarthritis (OA)?
A chronic joint disorder characterized by progressive cartilage degeneration, osteophyte formation, and capsular fibrosis.
What percentage of men above 60 years have symptomatic OA?
0.096
What percentage of women above 60 years have symptomatic OA?
0.18
Which joint is most commonly affected by OA?
Knee joint (70% of people over 60 have knee OA).
How does OA differ from simple wear and tear?
It is asymmetrically distributed, related to abnormal loading, and unaccompanied by systemic illness.
What are the two classifications of OA?
Primary (idiopathic) and Secondary (due to trauma, infections, inflammatory or metabolic conditions).
What is the main cause of primary OA?
Imbalance between synthesis and degradation of cartilage matrix components.
List some causes of secondary OA.
Trauma, congenital hip dislocation, infections (septic arthritis, TB), inflammatory diseases (RA, AS), metabolic conditions (gout), hematologic diseases (hemophilia), endocrine disorders (DM).
Which joints are most commonly affected by OA?
Knees (41%), hands (30%), hips (19%), spine (cervical/lumbar), first MTP joint.
What are the key clinical features of OA?
Middle age onset, loss of function, mild morning stiffness (<15 min), pain with use, swelling, gelling, bony deformity.
What are the radiographic features of OA in the knee?
Joint space narrowing, marginal osteophytes, subchondral cysts, bony sclerosis, malalignment.
What classification is used to grade OA radiographically?
Kellgren-Lawrence Classification.
What are Heberden’s nodes?
Hard bony enlargements at the DIP joints of the hand.
What are Bouchard’s nodes?
Hard bony enlargements at the PIP joints of the hand.
What is the hallmark deformity of OA in the first CMC joint?
Squared appearance due to osteophytes.
What are the goals of OA treatment?
Decrease pain, optimize mobility, maximize quality of life, reduce inflammation, slow disease progression, minimize drug toxicity, treat other organ damage, and regain lost function.
What are the early treatment principles for OA?
Maintain movement and strength, protect joints from overload, relieve pain, and modify daily activities.
What is the cornerstone of OA management?
Non-pharmacologic therapy.
What are key non-pharmacologic therapies for OA?
Exercise, weight loss, joint protection strategies, thermal modalities, TENS, acupuncture, patient education.
What are examples of joint protection strategies?
Using a cane, walker, patellar taping, and wedged lateral insoles.
How does heat therapy help in OA?
Relaxes muscles and stimulates blood flow.
How does cold therapy help in OA?
Eases muscle spasms and blocks pain signals.
What is the first-line analgesic for OA pain relief?
Paracetamol (acetaminophen).
What should be used if paracetamol fails?
Non-steroidal anti-inflammatory drugs (NSAIDs).
What are chondroprotective oral supplements for OA?
Glucosamine (stimulates cartilage metabolism) and chondroitin sulfate (inhibits degradative enzymes).
What are the benefits of intra-articular steroid injections?
Good pain relief, commonly used in knees, effective for 3-6 months.
What is a risk of frequent intra-articular steroid injections?
Increased risk of infection, worsening diabetes, or CHF.
What is joint lavage?
Flushing out inflammatory mediators from the joint, providing symptomatic relief.
What are hyaluronic acid injections used for?
Viscosupplementation, improving function and pain relief in early OA.
What are the limitations of hyaluronic acid injections?
Expensive, require multiple injections, limited to knee OA, and lack long-term benefit evidence.
What are indications for corticosteroid intra-articular injections?
Failure of first-line anti-inflammatory therapy, contraindications to NSAIDs, and unresponsiveness to non-surgical methods for 6-8 weeks.
What precautions should patients take after corticosteroid injections?
Avoid strenuous or prolonged weight-bearing activities for 48 hours.
What is the mainstay of early OA treatment?
Physiotherapy to maintain joint mobility and improve muscle strength.
What type of exercise should be avoided in OA?
High-impact activities like running and jumping.
What exercises are recommended for OA?
Low-impact activities like swimming, walking, and bicycling.
What are the main exercise goals in OA management?
Range of motion, muscle strengthening, and aerobics.
When should surgical treatment be considered for OA?
When lifestyle modifications and non-operative management fail to relieve symptoms.
What is joint debridement?
Surgical removal of osteophytes, cartilage tags, and loose bodies.
How does arthroscopy help in OA?
Lavage and debridement remove inflammatory mediators, providing pain relief for 50-70% of patients.
What are late-stage surgical options for OA?
Arthrodesis, osteotomy, and total joint replacement.
What is the goal of osteotomy in OA?
Realigning the joint to redistribute loading forces.
What is the ‘gold standard’ surgical treatment for OA?
Total joint replacement.
What is the success rate of total joint replacement?
90-95% of implants still function well after 10 years.
What is the first step in OA management?
Confirm pain is joint-related, not from tendonitis or bursitis.
What are the first-line treatments for OA?
Muscle strengthening exercises, walking programs, weight loss, acetaminophen, and topical agents.
What are the second-line treatments for OA?
NSAIDs, intra-articular agents, or joint lavage.
What are the third-line treatments for OA?
Arthroscopy, osteotomy, or total joint replacement.
