Osteoarthritis Flashcards
define
most common type of arthritis.
progressive degenerative condition affecting joints due to an imbalance of cartialge breakdown and repair, with gradual thinning of cartilage, loss of joint space and formation of osteophytes
osteophytes
bony spurs
inflammation?
there may be inflammation alongisde it, which can lead to flare ups periodically
risk factors
- environmental factors, hobbies and occupation may have an influence
- joints with abnormal alignment eg hypermobility, genu, fracture malunion
- previous injuries
- women
- age
- obesity
- familial factors
- genetics
- RA, gout, acromegaly
what can previous injuries cause
secondary OA
describe the pattern of joint involvement
usually asymmetrical and affects weight bearing or active joints
pathogenesis
- A combination of muscle weakness and ligament imbalance leads to uneven load at joint.
- Joint microtrauma causes release of cytokines (including IL-1 and TNF and metalloproteinases) – catabolic factors for cartilage ECM. This causes inflammation of the synovium and abnormal bone remodeling.
- Cartilage consists of predominantly collagen type II fibres linked by covalent bonds, conferring tensile strength
- There is loss of matrix. Fibrillation (softening and development of vertical clefts) of the cartilage surface (progressive loss by abrasion) and attempted repair with osteophyte formation then occurs.
describe a joint with mild arthritis
osteophytes
roughened, thinning cartilage
mild, thickened inflamed synovium
thickened stretched capsule
describe a joint with severe OA
what is the onset like
gradual
clinical features
mechanical pain
crepitus on movemenet
stiffness, inactivity gelling
bony swellings and deformity of joints
effusions and soft tissue swelling
mechanical pain
worse with activity and at the end of the day
relieved by rest
what can OA lead to
loss of function and mobility
joint deformity
commonly affected joints
what features are seen in the hands
what are the 2 most common sites for OA
- DIP
- base of thumb
what does OA in the base of the thumb lead to, and what particular movement makes pain worse
- subluxation of CMC joint
- worse on pinching movement
- thumb may ‘square’
what may there be on the hands with associated OA
dorsal ganglion cyst may be present
what is seen whe OA affects the knee
genu varum or valgum can predispose
osteophytes, effusions, crepitus and restriction of movement
bakers cyst
genu varum and valgum
due to abnormalitites in the medial and lateral menisci respectively.
varum - medial OA
valgus - lateral OA
bakers cyst
fluid filled swelling in popliteal fossa
also seen in RA
effects of OA in the hip
restriction of movement
pain may be felt in groin or radiate to knee
where may pain felt in the hip e from
lower back
OA in the spine
osteophytes can impinge on nerve root causing weakness and pins and needles
pain and restriction
spinal stenosis
diagnosis
history and examination are key
bloods - inflammatory markers usually normal
x ray
x ray features
loss of joint space
osteophytes
sclerosis
subchondral cysts
what treatment is available for elbow OA
- elbow replacement
- However, these are not good for young/active people and are limited to 5kg or 1kg repeatedly.
non pharmacological management
- Education
- Physiotherapy
- Weight loss
- Footwear
- Aids e.g. walking stick
first line analgesia
paracetamol and topical NSAIDs (for knees and hands)
2nd line analgesia
- oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids (short term relief)
what is NICE views on the use of viscosupplementation, hyaluronic acid injection, glucosamine or chondroitin.
they do not support it
surgical management
fusion, replacement or total excision
what surgery is available for varus knee
- osteotomy for isoated early medial OA compartment
- However, this has lower satisfaction rates than TKR, variable duration of effect, and can affect results of later TKR
- Is good in heavy manual workers. The results for valgus knee are less well established.
