osteoarthritis

Question 1

definition

Answer 1

most comment type of non-inflammatory arthritis, progressive degenerative disease involving the loss of hyaline cartilage in joints

Question 2

pathophysiology

Answer 2

• chondrocytes wishing cartilage are contained within the ECM and are responsible for maintaining the ECM
• for reasons unknown in osteoarthritis they begin to produce too much degradative enzymes which destroy the ECM and causes loss of type 2 collagen and proteoglycan reducing the elasticity and tensile strength of the cartilage

Question 3

presentation

Answer 3

• gradual onset usually over many years
• mechanical pain which is received by rest
• crepitus: grinding and clicking within joint
• morning stiffness which lasts less than 30 minutes
• effusion
• quadriceps muscle masting
• osteophytes can cause spinal stenosis if they encroach on lumbar spine
• deformities

Question 4

deformities in osteoarthritis

Answer 4

• herberdens nodes: posterolateral swelling of the distal interphalyngeal joints
• bouchards nodes; posterolateral swelling at the PIP joints
• squaring of the thumb due to wasting of the 1st carpometacarpal joint

Question 5

risk factors

Answer 5

old age, obesity, road running, crystal arhropathy, meniscal tears, ACL rupture

Question 6

x-ray shows

Answer 6

Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts

Question 7

conservative management

Answer 7

• NSAIDS, paracetamol and physiotherapy to strengthen muscle

Question 8

if NSAIDS contra-indicated what do you use

Answer 8

colchicine but very common side effect is diarrhoea so don’t give too high a dose

Question 9

when would NSAIDS and colchicine be contra-indicated

Answer 9

in renal disease so you may then have to use inta-articualr steroids

Question 10

if all conservative management has failed

Answer 10

if they are experiencing a lot of pain and disability then joint replacement is the last option