Osteoarthritis

Question 1

Causes of primary osteoarthritis

Answer 1

1. Overweight/metabolic syndrome (not just a weight-loading effect)
2. Genetic predisposition

Question 2

Causes of secondary osteoarthritis (7)

Answer 2

1. Joint injury
2. Septic arthritis
3. Congenital disorders of joints
4. Marfan syndrome
5. Obesity
6. Diabetes
7. Haemochromatosis and Wilson’s disease

Question 3

Pathophysiology of osteoarthritis, including both gross and biochemical changes

Answer 3

Biochemical changes

• Loss of collagen to a greater extent than loss of proteoglycans, leading to a net increase in cartilage water content
• Inflammation due to breakdown products in synovial space

Gross changes

• Loss of cartilage and subchondral bone
• Osteophyte formation

Question 4

Symptoms of osteoarthritis (4)

Answer 4

1. Joint pain - aching and worse in the evening
2. Stiffness
3. Swelling
4. Mechanical symptoms - clicking, locking

Question 5

Signs of osteoarthritis (4)

Answer 5

1. Deformity (including Bouchard’s and Herbeden’s nodes on the PIPs and DIPs respectively, and bunions on the toes)
2. Muscle atrophy
3. Effusion
4. Crepitus

Question 6

Signs of osteoarthritis on x-ray

Answer 6

LOSS

• Loss/narrowing of joint space
• Osteophytes
• Subchondral sclerosis
• Subchondral cysts

Question 7

Management of osteoarthritis, including name of first line analgesic

Answer 7

1. Lifestyle (weight loss, exercise)
2. Acetaminophen,
3. Joint arthroplasty

Other options include NSAIDs (naproxen), opioids, topical creams, steroid injections, hyaluronic acid injections and glucosamine supplements.