Osteoarthritis Flashcards
1
Q
definition
A
Most common degenerative bone disease, affects articular cartilage
2
Q
Epidemiology
A
- commonest type of arthritis
- age
- after menopause
- female sex
- hypermobility
- obesity
- weight bearing joints
3
Q
Classification of osteoarthritis
A
- Primary
- Secondary
4
Q
Primary osteoarthritis
A
- Localised
- hands
- feet
- knee
- hip
- spine
- generalised
- 3+ joints
5
Q
Secondary osteoarthritis
A
- localised
- hip
- mechanical/local factors e.g obesity
- generalised
- general e.g bone dysplasia
- calcium disease e.g psuedogout
- endocrine e.g acromegaly
- bone joint disorders e.g avascular necrosis
6
Q
Pathology of osteoarthritis
A
All joint tussyes involved- bone, ligament, capsule, synovial membrane
dynamic process:
- most OA is primary with no obvious predisposing factor . Secondary OA occurs in joints that have been damaged in some way or are congenitally abnormal
- OA is a result of active, sometimes inflammatory but potentially reparative processes
- characterised by a progressive destruction and loss of articular cartilage
- the exposed subchondral bone becomes sclerotic with increased vascularity and cyst formation
- attempts at repair produce cartilagenous growth at the margins of the joints which later become calcified (osteophytes)
- most common in weight bearing joints
7
Q
Risk factors
A
8
Q
Symptoms of Osteoarthritis
A
- pain
- aching
- worse with weight bearing/activity, better with rest
- from all tissues except articular cartilage e,g subchondral bone, synovtis, inflammatory effusions, capsular distention, enthesitis, muscle spasm
- transient stiffness- stiffness after rest or in the morning <30 minutes
- functional impairment due to restricted movement
9
Q
Signs of osteoarthritis
A
- Common joints - DIPJ and 1st carpometacarpal joint of the hands, 1st MTP join of the foot and weight bearing joints
- restriction of movement
- palpable bony swelling
- peri-articular/joint line tenderness
- joint deformitiy
- joint instability
- muscle weakness/wasting
- joint effusion
- palpable/audible crepitus
10
Q
Radiograph features
A
LOSS
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- Subchondrall cysts
11
Q
Management
A
Main aims:
- relieve symptoms
- maintain/improve joint function
- minimise disability.handicap
3 options
- non-pharacological (education, weight loss, sensible footwear)
- non pharma (physio, analgesiacs)
- Pharma (opiods, NSAIDS)
- surgery (total joint replacement)
12
Q
Investigations
A
- Blood tests
- bone profile, ferritin
- synovial fluid analysis
- exclude infection or crystal arthropathy
- Xrays
- MRI
- Istope scans
- Bone scintigraphy
13
Q
Non-pharmacological management
A
- education
- exercise
- weight loss
- appropriate footwear
- occupation injury prevention
- physiotherapy referral
- orthotics/braces
- heat or ice packs
- acupuncture
- TENS
14
Q
Pharmacological management
A
- paracetamol
- NSAIDs
- lots of contraindications
- Consider COX2 inhibitor for those with increased GI risk
- Consider gastro-protective cover
- Topical NSAIDs or topical capsaicin- hand and knee OA
- intra-articular steroid injections
- intra-articular hyaluronate - as effective as steroids/NSAIDS but more expensive
- glucosamine and or chondroifin sulphate
- opiods
15
Q
Surgical management
A
- replacement arthroplasty
- effective symptom relief
- cost effective
- associated risks
- infection
- dislocation
- loosening
- osteotomy/joint preserving surgery
20
Q
Clincal presentations- hands
A
Symptoms
- DIP, PIP, CMC joints
- Pain, swelling and stiffness
- Restricted movements
- Hand function preserved
- Usually bilateral
- Women >> Men
- Peri-menopausal onset
Signs
- Heberdens (DIP joints) and bouchards nodes (PIP joints)
- subluxation 1st CMC
- squaring of hand
- Usually OA in other joints
