Osteoarthritis

Question 1

Who does osteoarthritis affect?

Answer 1

It is the commonest joint condition. It affects most people over 60 yrs.
Women are 3X more effected than men.

Question 2

What areas are most affected by osteoarthritis?

Answer 2

Hip and knee

then shoulder, wrist and finger joints

Question 3

What are the symptoms of osteoarthritis?

Answer 3

joint pain
stiffness and pain after immombility
instability
loss of function

Question 4

What is seen on the hands months/years after the inflammation settles

Answer 4

Heberden’s nodes on distal IP joints.

Bouchard’s nodes of periferal IP joints.

+stiffness +deformity

Xray shows osteophytes and loss of joint space

Question 5

what happens to a thumb affected by osteoarthritis?

Answer 5

-fixed thumb adduction (decreased movement) –> loss of function

Question 6

What part of the knee is commonly affected by OA, and what deformity does it lead to?

Answer 6

Medial compartment affected —-> VARUS (bow legged deformity)

Question 7

What are the risk factors for OA of the knee?

Answer 7

• trauma
• meniscal tear
• cruciate ligament tear

Question 8

What are the signs of an OA joint on an Xray?

use LOSS

Answer 8

LOSS
L - loss of joint space
O - osteophytes (bony spurs)
S - Subarticular sclerosis (increased bone density / hardening of bone near the joint)
S - Sunchondral cysts (fluid filled sac inside the bone, & can extend out)

Question 9

What is the typical presentation of osteoarthritis of the knee?

Answer 9

• pain on movement (better at rest)
• crepitus
• knee pain worse at end of day
• stiffness
• reduced movement

Question 10

How is OA managed?

Answer 10

Lifestyle:

• weight loss
• exercise to improve muscle strength

Analgesia:
1) paracetamol + topical NSAID
OR
Codiene

2) steroid injection
3) Physiotherapy
4) Surgery (joint replacement)

Question 11

What is the difference between Osteoarthritis and Rheumatoid arthritis?

Answer 11

There is a lot of overlap but here are the differences:

1) Onset
- RA (25 -55yrs) (weeks to months)
- OA (after 40 yrs) (slowly over years)

2) Cause
- RA (autoimmune destruction of of synovial membrane)
- OA (wear and tear / use of joint leads to destruction of cartilage)

3) Joints affected
- RA (symmetrical, usually small joints)
- OA (affects weight bearing joints e.g. knee, hip, lower spine, unilateral or bilateral)

4) Both have morning stiffness
- RA (morning stiffness for over 1 hour)
- OA (morning stiffness for 20 mins)

5) Who does it affect:
- RA (more in females)
- OA (commonly found in men and women)

6) Associated symptoms:
- RA (fatigue, weight loss, anaemia)
- OA (no feeling of unwellness)

Question 12

What is are the causes of osteoarthritisʔ

Answer 12

Pre-existing joint damage fromː

• ʀA
• ɢout
• Paget’s disease
• Avascular necrosis

Metabolic diseaseː

• Chondracalcinosis
• ʜereditary haemochromatosis
• Acromegaly

Systemic Diseasesː

• ʜaemophilia
• ʜaemarthrosis
• ʜaemoglobinopathies e.g. sickle cell.

Question 13

What are the risk factors for OA

Answer 13

1) genetics
2) Female > M (weight bearing sport in women increases risk)
3) Age
4) diet (lack of antioxidants)
5) Obesity
6) Trauma (joint fractures)
7) Occupation (increased use of joints)
8) sport (injury / repeted use)

***ɪnterestingly Osteoporosis has an inversed relationship with OA.

Question 14

What investigations are done to confirm OA diagnosisʔ

Answer 14

1) Xray (loss of joint space, Osteophytes, subarticular sclerosis, subachondral cysts)
2) Bloods (raised CʀP, rheumatoid factor negative, anti nuclear antibodies negative)
3) Mʀɪ shows meniscal tear, cartilage injury, subchondral bone change.
4) Arthroscopy shows erosion of cartilage and fissures.
5) Aspiration of synovial fluid shows viscous fluid with few leucocytes.