Osteoarthritis

Question 1

What is the male:female ratio of OA?

Answer 1

M 3:1 F

Question 2

What are the most common joints affected?

Answer 2

Knee, hip

Question 3

What is the pattern of disease of OA?

Answer 3

Most commonly it is localised and asymmetrical

Question 4

What are the signs and symptoms of OA?

Answer 4

• Pain on movement
• Crepitus
• Worse at the end of the day
• Background pain at rest
• Joint ‘gelling’ (stiffness after rest of up to 30 mins)
• Joint instability

Question 5

What are the features of generalised OA?

Answer 5

• Heberden’s nodes (Nodal OA most commonly seen in post menopausal women)
• Commonly affects the DIP joints, thumb carpometacarpal joints and knees
• Joint tenderness and bony swelling (Heberden’s nodes at DIP, Bouchard’s nodes at PIP)
• Reduced range of movement and synovitis

Question 6

What might you see on a plain radiograph?

Answer 6

“LOSS”

• ‘L’oss of joint space
• ‘O’steophytes
• ‘S’ubarticular sclerosis
• ‘S’ubchondral cysts

CRP may be slightly raised

Question 7

What are the core treatments of OA?

Answer 7

1) Exercise - improves local muscle strength and general fitness (irrespective of age)
2) Weight loss if overweight

Question 8

What type of analgesia is normally offered?

Answer 8

1) Regular paracetamol +/- topical NSAIDS
2) If this is ineffective, consider codeine or short term oral NSAID (+PPI)
3) Topica capsaicin
4) Intra-articular steroid injections
5) Intra-articular hyaluronic acid injections

Question 9

What are the non-pharmacological treatments of OA?

Answer 9

Multidisciplinary approach using physiotherapists and Occupational therapists.

Question 10

What is the definitive treatment for severe OA that affects quality of life?

Answer 10

Joint-replacement surgery!

Question 11

For information about prescribing NSAIDs, see pharmacology section

Answer 11

:)