Osteoarthritis Flashcards
What is the epidemiology of OA?
- Most common arthropathy
- F>M
- 80-90% in hips by 80y
Which joints are commonly affected by OA?
Main weight bearing joints (spine, hips, knees). Rare in ankle.
DIPs not spared DIP, PIP, 1st CMC).
Asymmetric joint involvement.
What is the pathophysiology of OA?
Deterioration of articular cartilage due to local biomechanical factors and release of proteolytic and collagenolytic enzymes. Catabolism > anabolism. Loss of water and proteoglycans exposes bone -> change to bone metabolism.
What are the RFx OA?
- Female gender
- Obesity
- Increasing age
- Trauma
- Genetics
What are the signs of OA?
- Joint line tenderness
- Bony enlargement at joints
- Deformity
- Limited ROM
- Crepitus on passive ROM
- Inflammation
- Periarticular muscle atrophy
What are the symptoms of OA?
Joint pain with motion; relieved with rest. Short duration of stiffness after immobility. With joint instability/locking.
What are the radiographic signs of OA?
1) Joint space narrowing
2) Subchondral sclerosis
3) Subchondral cysts
4) Osteophytes
Describe OA of the hand.
- DIP (Heberden’s nodes = osteophyts)
- PIP (Bouchard’s nodes - Bouchard’s closer to the BODY)
- CMC (usually thumb sparing)
- 1st MCP (others spared).
Describe OA of the hip.
Presents as dull groin pain +/- trochanteric area pain. Internal rotation and abduction lost first. May radiate to anterior thigh.
Describe OA of the spine.
Common esp L4/5, L5/S1.
Degeneration of discs and facet joints.
Reactive bone growth may lead to neurological impingement.
Rx of OA?
Non pharm: weight loss, rest, PT/OT
Pharm: NSAIDs, glucosamine + chondroitin, injections (steroid/hyaluronic acid), topical NSAIDs.
Surgical Mx of OA?
Joint debridement, osteotomy, replacement.
Ix in OA work up?
- Bloods (FBE, ESR, CRP): NAD
- ve RF and ANA
- Radiography
- Synovial fluid: non-inflamm
Key issues to elicit in ?OA Hx?
- Age
- Time frame: chronic
- Distribution of pain
- Presence of low back pain
- Presence of any neuro symptoms
- Previous injury
- FHx arthritis
Red flag conditions relating to hip pain?
Infection, fracture, malignancy
Causes of low back pain?
- Facet joint OA
- Disc degeneration/herniation
- Inflammatory back pain: ankylosing spondylitis, psoriatic arthritis, reactive arthritis
- Fractures: osteoporosis, malignancy, trauma
- Infection: discitis, osteomyelitis, epidural abscess
- Intra-abdo pathology: AAA, renal, pelvic
Summation shadow of overlapping lumbar vertebrae appearance?
Summation shadows of 2 overlapping lumbar vertebrae in oblique view plain XR said to resemble scotty dog outline.
Common cause of spinal canal stenosis?
Usually caused by combination of:
- facet joint OA
- ligamentum flavum hypertrophy
- disc herniation
Clinical syndrome caused by spinal canal stenosis?
Lumbar claudication:
- lumbar/buttock/thigh pain
- usually uni- may be bi-lateral
- NOT present at rest
- comes with exercise
- reproducible walking distance
- nerve roots become compressed
Back pain Hx features?
- Site: localised or diffuse
- Radiation: consider referred (MSK, visceral) and radicular (nerve root irritation).
- Timing: onset, progression
- Aggravators and Relievers
Exclude infection, malignancy, trauma (?#)
How do degenerative back conditions usually start?
Traumatic/degenerative disc pathology with vertebral changes developing thereafter (i.e. facet joint OA).
What is most recent onset MSK pain due to?
Self limiting musculoligamentous origin
