Osteoarthritis

Question 1

What is the MC joint d/o in the US?

Answer 1

Osteoarthritis!

Question 2

What is the pathology of OA?

Answer 2

Joint failure involving the entire joint where articular cartilage degenerates, mild inflammation w/ flares
Microfractures –> bone proliferates (healing) –> interferes w/ joint fxn –> pain & inflammation
Chondrocytes migrate to cartilage surface

Question 3

A 69 yo female presents complaining of pain in her knees that is worse with walking or climbing stairs. The pain has been getting worse over the past few years, but recently she has noticed that her knees will be stiff, usually for about 20 minutes. She also noticed that she can’t bend them as much as she used to, and when she does they make crackling or popping noises. Her knees are tender and appear slightly enlarged. What might you see on this pts X-rays?

Answer 3

OA
Joint space narrowing
Osteophytes
Subchondral cyst

Question 4

A 72 yo male presents complaining of hip pain with increasing use. He mentions some stiffness that usually resolves pretty quickly. Exam shows decreased ROM, Crepitus with flexion and extension, bony proliferation at the joint margin, and subchondral bony sclerosis. X-Ray shows asymmetrical joint space narrowing. What non-pharm Tx could you recommend?

Answer 4

OA of the hip
PT, muscle toning, exercise bike, walking fitness program, cane/walker, shoe inserts, grab bars/toiler extenders/seat lift chairs, handicap parking
Weight loss of 5 kg to slow progression

Question 5

A 65 yo female presents complaining of pain at the base of her thumb. Her pain increases with use, and exam shows decreased ROM with crepitus, thenar atrophy, and Heberden’s/Bouchard’s nodes. There is no heat/redness and she doesn’t have any wrist pain. XRay shows a saddle joint. She said that her pain is really bad right now, much worse than it usually is. What treatment should you recommend?

Answer 5

OA of the hand
Topical agents: Capsain, Methylsalicylate, menthol, camphor, bio-freeze, diclofenac topical, flector patch, pennsaid lotion
NSAIDS 
APAP
Tramadol, Codeine, Oxycodone, morphine

Question 6

A 67 yo female presents with knee pain that worsens throughout the day but is relieved with rest. She is complaining of stiffness, usually for 25 min, as well as a popping/crackling noise when she moves her knees. XRay shows a narrowed joint space. After failing to be controlled by lifestyle changes or pharmaceutical Tx, what could you recommend?

Answer 6

OA
Joint aspirations
Joint injections
TKR if night pain unresponsive to meds, major inability, interferes w/ daily activities, unable to walk/work, or bone-on-bone

Question 7

What else is needed to diagnose OA in a pt with knee pain, osteophytes on XRay, and asymmetrical narrowing on XRay?

Answer 7

OA
Age > 50 OR
Stiffness < 30 min OR
Crepitus