Osteoarthritis

Question 1

What is osteoarthritis (OA)?

Answer 1

A chronic joint disorder characterized by progressive cartilage degeneration, osteophyte formation, and capsular fibrosis.

Question 2

What percentage of men above 60 years have symptomatic OA?

Answer 2

0.096

Question 3

What percentage of women above 60 years have symptomatic OA?

Answer 3

0.18

Question 4

Which joint is most commonly affected by OA?

Answer 4

Knee joint (70% of people over 60 have knee OA).

Question 5

How does OA differ from simple wear and tear?

Answer 5

It is asymmetrically distributed, related to abnormal loading, and unaccompanied by systemic illness.

Question 6

What are the two classifications of OA?

Answer 6

Primary (idiopathic) and Secondary (due to trauma, infections, inflammatory or metabolic conditions).

Question 7

What is the main cause of primary OA?

Answer 7

Imbalance between synthesis and degradation of cartilage matrix components.

Question 8

List some causes of secondary OA.

Answer 8

Trauma, congenital hip dislocation, infections (septic arthritis, TB), inflammatory diseases (RA, AS), metabolic conditions (gout), hematologic diseases (hemophilia), endocrine disorders (DM).

Question 9

Which joints are most commonly affected by OA?

Answer 9

Knees (41%), hands (30%), hips (19%), spine (cervical/lumbar), first MTP joint.

Question 10

What are the key clinical features of OA?

Answer 10

Middle age onset, loss of function, mild morning stiffness (<15 min), pain with use, swelling, gelling, bony deformity.

Question 11

What are the radiographic features of OA in the knee?

Answer 11

Joint space narrowing, marginal osteophytes, subchondral cysts, bony sclerosis, malalignment.

Question 12

What classification is used to grade OA radiographically?

Answer 12

Kellgren-Lawrence Classification.

Question 13

What are Heberden’s nodes?

Answer 13

Hard bony enlargements at the DIP joints of the hand.

Question 14

What are Bouchard’s nodes?

Answer 14

Hard bony enlargements at the PIP joints of the hand.

Question 15

What is the hallmark deformity of OA in the first CMC joint?

Answer 15

Squared appearance due to osteophytes.

Question 16

What are the goals of OA treatment?

Answer 16

Decrease pain, optimize mobility, maximize quality of life, reduce inflammation, slow disease progression, minimize drug toxicity, treat other organ damage, and regain lost function.

Question 17

What are the early treatment principles for OA?

Answer 17

Maintain movement and strength, protect joints from overload, relieve pain, and modify daily activities.

Question 18

What is the cornerstone of OA management?

Answer 18

Non-pharmacologic therapy.

Question 19

What are key non-pharmacologic therapies for OA?

Answer 19

Exercise, weight loss, joint protection strategies, thermal modalities, TENS, acupuncture, patient education.

Question 20

What are examples of joint protection strategies?

Answer 20

Using a cane, walker, patellar taping, and wedged lateral insoles.

Question 21

How does heat therapy help in OA?

Answer 21

Relaxes muscles and stimulates blood flow.

Question 22

How does cold therapy help in OA?

Answer 22

Eases muscle spasms and blocks pain signals.

Question 23

What is the first-line analgesic for OA pain relief?

Answer 23

Paracetamol (acetaminophen).

Question 24

What should be used if paracetamol fails?

Answer 24

Non-steroidal anti-inflammatory drugs (NSAIDs).

Question 25

What are chondroprotective oral supplements for OA?

Answer 25

Glucosamine (stimulates cartilage metabolism) and chondroitin sulfate (inhibits degradative enzymes).

Question 26

What are the benefits of intra-articular steroid injections?

Answer 26

Good pain relief, commonly used in knees, effective for 3-6 months.

Question 27

What is a risk of frequent intra-articular steroid injections?

Answer 27

Increased risk of infection, worsening diabetes, or CHF.

Question 28

What is joint lavage?

Answer 28

Flushing out inflammatory mediators from the joint, providing symptomatic relief.

Question 29

What are hyaluronic acid injections used for?

Answer 29

Viscosupplementation, improving function and pain relief in early OA.

Question 30

What are the limitations of hyaluronic acid injections?

Answer 30

Expensive, require multiple injections, limited to knee OA, and lack long-term benefit evidence.

Question 31

What are indications for corticosteroid intra-articular injections?

Answer 31

Failure of first-line anti-inflammatory therapy, contraindications to NSAIDs, and unresponsiveness to non-surgical methods for 6-8 weeks.

Question 32

What precautions should patients take after corticosteroid injections?

Answer 32

Avoid strenuous or prolonged weight-bearing activities for 48 hours.

Question 33

What is the mainstay of early OA treatment?

Answer 33

Physiotherapy to maintain joint mobility and improve muscle strength.

Question 34

What type of exercise should be avoided in OA?

Answer 34

High-impact activities like running and jumping.

Question 35

What exercises are recommended for OA?

Answer 35

Low-impact activities like swimming, walking, and bicycling.

Question 36

What are the main exercise goals in OA management?

Answer 36

Range of motion, muscle strengthening, and aerobics.

Question 37

When should surgical treatment be considered for OA?

Answer 37

When lifestyle modifications and non-operative management fail to relieve symptoms.

Question 38

What is joint debridement?

Answer 38

Surgical removal of osteophytes, cartilage tags, and loose bodies.

Question 39

How does arthroscopy help in OA?

Answer 39

Lavage and debridement remove inflammatory mediators, providing pain relief for 50-70% of patients.

Question 40

What are late-stage surgical options for OA?

Answer 40

Arthrodesis, osteotomy, and total joint replacement.

Question 41

What is the goal of osteotomy in OA?

Answer 41

Realigning the joint to redistribute loading forces.

Question 42

What is the 'gold standard' surgical treatment for OA?

Answer 42

Total joint replacement.

Question 43

What is the success rate of total joint replacement?

Answer 43

90-95% of implants still function well after 10 years.

Question 44

What is the first step in OA management?

Answer 44

Confirm pain is joint-related, not from tendonitis or bursitis.

Question 45

What are the first-line treatments for OA?

Answer 45

Muscle strengthening exercises, walking programs, weight loss, acetaminophen, and topical agents.

Question 46

What are the second-line treatments for OA?

Answer 46

NSAIDs, intra-articular agents, or joint lavage.

Question 47

What are the third-line treatments for OA?

Answer 47

Arthroscopy, osteotomy, or total joint replacement.