Osteoarthritis

Question 1

what is OA a consequence of?

Answer 1

complex interplay of many factors, mainly wear & tear of a joint

Question 2

what is OA?

Answer 2

arthritis in weight baring joints

Question 3

what happens to the joint in OA?

Answer 3

• articular cartilage thinning or loss
• subchondral sclerosis
• loss of joint space
• subchondral cyst formation
• osteophyte formation

Question 4

what is the pathogenesis of OA?

Answer 4

• loss of matrix of cartilage due to increase in protease:inhibitor ratio
• release of cytokines including IL1, TNF & mixed metalloproteinases
• release of prostaglandins by the chondrocytes
• fibrillation of cartilage surface
• attempted repair with osteophyte formation

Question 5

what are the normal constituents of cartilage?

Answer 5

chondrocytes

extracellular matrix - collagen type 2, proteoglycans & water

Question 6

what would happen if all of the chondrocytes in cartilage were to die?

Answer 6

no more ECM would be produced at all

Question 7

what are the types of OA?

Answer 7

• idiopathic
• secondary
• generalised

Question 8

where will idiopathic OA be found?

Answer 8

will be localised

• hands
• feet
• keen
• hip
• spine

Question 9

what could secondary OA be due to?

Answer 9

• previous injury
• RA
• genetic elements
• acromegaly
• calcium crystal deposition disease

Question 10

how can generalised OA be diagnosed?

Answer 10

by the involvement of 3+ joints

Question 11

name some risk factors for OA?

Answer 11

• age
• female more common
• obesity
• occupation
• sports
• previous injury
• muscle weakness
• proprioceptive deficits
• genetic elements
• underlying disease

Question 12

what symptoms would you expect to see in OA?

Answer 12

• pain

- stiffness, worse in the morning but lasting less than 30 mins

Question 13

describe the pain in OA

Answer 13

typically worse on activity and relieved by rest. May progress to be present with less activity and at rest or at night.

Question 14

what would you expect to find on examination

Answer 14

crepitus
bony enlargements due to osteophytes
joint tenderness
joint effusion

Question 15

what would likely happen to the hands

Answer 15

DIP, PIP & 1st CMC joints
bony enlargements at DIPS
squaring of thumb

Question 16

heberdens nodes

Answer 16

bony enlargement at DIPJs

Question 17

bouchards nodes

Answer 17

bony enlargement at PIPJs

Question 18

what would you likely see at the knees

Answer 18

osteophytes
effusions 
crepitus 
reduced ROM
genu varus/valgus deformities 
bakers cyst

Question 19

what likely happen at the hip

Answer 19

pain may be felt in groin or radiating to the knee
pain in the hip could be from lower back
hip ROM reduced

Question 20

what would likely happen in the cervical spine

Answer 20

pain
restricted ROM
osteophytes may impinged nerve roots

Question 21

what could happen in the lumbar spine

Answer 21

osteophytes can cause spinal stenosis if they impinge on the spinal canal

Question 22

what would you see on an X-ray of a joint affected by OA?

Answer 22

L - loss of joint space
O - osteophytes
S -subchondral sclerosis
S - subchondral cysts

Question 23

what grading scale can be used in OA?

Answer 23

Kellgren-lawrence radiographic grading scale (0-4)

Question 24

what is Kellgren-Lawrence grade 0

Answer 24

no radiographic findings of OA

Question 25

what is Kellgren-Lawrence grade 4

Answer 25

definite osteophytes with severe joint space narrowing & subchondral sclerosis

Question 26

how would OA be diagnosed?

Answer 26

history
examination
no specific lab tests
x-ray

Question 27

what is the non-pharmacologic management of OA?

Answer 27

explanation
physiotherapy
common sense measures - weight loss, exercise, trainers, walking stick

Question 28

what is the pharmacologic management of OA?

Answer 28

analgesia
NSAIDs
pain modulators

Question 29

what analgesic could you give

Answer 29

paracetamol
compound analgesics
topical analgesis

Question 30

what pain modulators could you give

Answer 30

tricyclics e.g. amitriptyline

anti-convulsants e.g. gabapentin

Question 31

what intra-articular management could be used

Answer 31

steroids

hyaluronic acid

Question 32

what surgical management could be used

Answer 32

arthroscopic washout of loose body & soft tissue trimming
joint replacement