Osteoarthritis Flashcards
Define osteoarthritis
Age-related degenerative synovial joint disease when cartilage destruction exceeds repair, causing pain and disability.
Describe the epidemiology of osteoarthritis
Common, with 25% of those >60 years symptomatic
(70% have radiographical changes).
More common in females, Caucasians and Asians
Describe the pathogenesis of osteoarthritis.
Affects entire joint but especially the cartilage.
Pathogenesis is complex and involves cartilage degradation.
Process mediatied by enzymes, metalloproteinases and cytokines.
Synovial joint cartilage fissuring and fibrillation. Eventually, there is loss of joint volume as a result of altered chondrocyte activity, subchondral sclerosis, bone cysts, osteophyte formation, patchy chronic synovial inflammation and fibrotic thickening of the joint capsules
Describe predisposing factors to primary and secondary osteoarthritis.
Primary: Aetiology unknown. Likely to be multifactorial; wear and tear concept.
Secondary: Other diseases can cause altered joint architecture and stability. Commonly associated diseases include:
Developmental abnormalities (e.g. hip dysplasia, Perthesdisease, slipped femoralepiphysis)
Trauma (e.g. previous fractures).
Inflammatory (e.g. rheumatoid arthritis, gout, septic arthritis).
Metabolic (e.g. alkaptonuria, haemochromatosis, acromegaly).
What would a patient presenting with osteoarthritis complain of in their history?
Joint pain or discomfort, usually use-related, stiffness or gelling after inactivity.
Difficulty with certain movements or feelings of instability.
Restriction walking, climbing stairs, manual tasks.
Systemic features are typically absent.
What could be found on examination of a patient with osteoarthritis?
Local joint tenderness. Bony swellings along joint margins,
e. g.
- Heberdens nodes (at distal interphalangeal joints).
- Bouchards nodes (at proximal interphalangeal joints).
Crepitus and pain during joint movement, joint effusion. Restriction of range of joint movement
Where would you find Heberden’s nodes?
Distal Interphalangeal Joints
Where would you find Bouchard’s nodes?
Proximal interphalangeal nodes.
What investigations would you perform for a patient with suspected osteoarthritis?
Lab investigations typically not helpful.
Radiography must be performed
-It is common to see discordance between symptoms and radiograph findings.
Synovial fluid analysis:
Clear synovial fluid.
Viscous with low cell count and cartilage fragments.
What features would you look for on an X ray to confirm Osteoarthritis?
- Joint space narrowing (from cartilage loss)
- Subchondral cysts.
- Subchondral sclerosis
- Osteophytes.
How would you manage a patient with osteoarthritis?
Treatment goals include symptom relief, optimizing joint function, minimizing disease progression and limiting disability.
Medical:
Analgesia with paracetamol, codeine, NSAIDs, COX-2 inhibitors, quinine and glucosamine.
Topical NSAIDs or capsaicin provide benefit in some.
Intra-articular injection of steroids and hyaluronic acid provides good symptomatic relief.
Tidal irrigation (intra-articular instillation of normal saline) is not very effective.
Supportive: Patient education.
Encourage lifestyle changes (e.g. weight loss, exercise).
Physiotherapy, occupational therapy and psychosocial support.
Surgical: Various techniques can provide benefit, such as arthroscopic irrigation, osteophyteremoval, joint replacement (arthroplasty) joint fusion (arthrodesis).
What complications are associated with osteoarthritis?
Pain and disability, nerve entrapment syndromes, falls and fractures caused by reduced mobility
What is the prognosis for a patient with osteoarthritis?
Although symptoms may improve or worsen in phases, disease evolution is usually slow, with the natural history depending on the joint site involved.
