Osteoarthritis

Question 0

Two main types of osteoarthritis?

Answer 0

Primary - no known cause, but genetic factors, age and occupation. Involves one or at most 2 joints, usually large weight bearing joints (knees and hips). Most common in post-menopausal women,

Secondary - following previous injury to bone joint. Confined to joints previously affected by trauma or disease. Increased wear and tear. Most people over 45 have some form of arthritis

Question 1

Osteoarthritis definition?

Answer 1

Degenerative and progressive disease. Degeneration of joint cartilage and the underlying bone.

Question 2

Causes of osteoarthritis??

Answer 2

Obesity -encourage exercise
Malalignment from fracture, not healed correctly
Joint instability - ligament laxity
Developmental abnormalities - SUFE (bone condition)
Inflammatory disease - ie gout

Question 3

Pathology (what happens in the joints) in osteoarthritis

Answer 3

Changes in the joint and articular surface
Softening of cartilage - flaking of surface -extends deep into cartilage.
Gradually cartilage is lost & denuded bone becomes thickened, polished & shiny
Beneath this shiny bone, cysts are formed
New bone formation taking place gives rise to outgrowths of bone, osteophytes & the margins of articular cartilage.
Cast off flakes of cartilage are removed from joint cavity from the joint cartilage by synovial membrane
Osteophytes may break off becoming loose in the joint, further impairment of movement and pain.

Question 4

Diagnosis of osteoarthritis, tests etc

Answer 4

Arthroscopy: a type of keyhole surgery used to diagnose and treat problems in joints
MRI scanning
Blood testing for molecular markers
^ these will lead to earlier diagnosis and intervention.

X-ray findings and later findings: 
Narrowing of the joint space
Sclerosis of articular ends of the bone osteophytic lipping 
Cyst formation
Deformity of the joint

Question 5

Consecutive measures/medical management of osteoarthritis?

Answer 5

Aim: pain relief, prevention/correction of deformity & restoration of joint function.

• weight loss
• activity has to be modified to suit disability
• periods of rest, balanced with gentle exercise
• drug therapy: NSAIDs ( ibubrofen, brufen, fruben), injection of steriods into joint space, disease modifying osteoarthritic drugs in early stages.

Question 6

Surgical measures/management of osteoarthritis.

Types of surgery?

Answer 6

Considered when consecutive measures have failed or when the disease is advanced - severe pain, deformity and disability
Consider, will surgery improve quite of life for patient?

Types of surgery:
Debridement - not common (clear out of joint)
Osteotomy - division of bone, pain relief as altering the mechanics of weight distribution.
Arthroplasty: false joint, usually hip or knee (hip replacement)
Arthrodesis - joint fusion (mainly done on ankle)

Question 7

Patient presentation of osteoarthritis?

Answer 7

Pain 
Loss of movement: grating and stiffness
Swelling
Muscle loss - due to immobility 
Altered function

Question 8

Self management of osteoarthritis?

Answer 8

Provide pt with information to empower their choices - from diagnosis to treatment available (continued support)
Empathetic relationships with health providers
Holistic individuality