Osteoarthritis

Question 1

Define osteoarthritis

Answer 1

General ‘wear and tear’ of a joint.

-most common joint pathology

Question 2

What are the risk factors of OA?

Answer 2

CONSTITUTIONAL
Ageing*
Female
Obesity

BIOMECHANICAL
High/Low bone density
Joint injury
Occupation
Joint laxity

GENETIC
40-60% hereditary

Question 3

What are common disease causes of secondary OA?

Answer 3

• Pre-existing joint damage
• RA, gout, Serengeti don’t spondyloarthropathy, septic arthritis, Paget’s disease, Avascular necrosis
• Metabolic disease
• Acromegaly, haemochromatosis
• Iatrogenic
• Post-surgery
• Trauma
• Fractures/ligament injury
• Systemic disease
• Haemophilia, neuropathic

Question 4

What are the symptoms of OA?

Answer 4

Joint pain*

• Exacerbated by movement, relieved by rest
• Knee pain = bilateral
• Hip pain = groin/anterior/arterial thigh

Joint stiffness
-Morning <45mins or after rest

Reduced function

Question 5

What are the signs of OA?

Answer 5

• RoM –
• Pain on movement
• Joint swelling/synovitis
• Periarticular tenderness
• Crepitus
• Absence of systemic features (e.g. Fever & rash)
• Bony swellings due to osteophytes (Herberden’s node = DIP, Bouchard’s Nodes = PIP)
• Joint instability
• Muscle wasting

Question 6

What are the X-Ray findings of OA?

Answer 6

LOSS

Loss of joint space
Osteophytes
Subchondral Cysts
Subchondral sclerosis

Question 7

How is OA managed?

Answer 7

CONSERVATIVE
Lifestyle = weight loss, aerobic fitness, muscle strengthening exercises, physio

MEDICATION
1st line: Paracetamol and topical NSAIDs
-oral NSAIDs / COX-2i (w/PPIs), opioids, capsaicin cream, intra-articular steroid injections

OTHER
-Supports, braces, TENs, shock-absorbing insoles

SURGICAL

• Joint replacement, realignment osteotomy, fusion, excision arthroplasty
• Debride and washout (temporary relief)