Osteoarthritis

Question 1

What is the most common form of arthritis?

Answer 1

Osteoarthritis

Question 2

What type of disorder is osteoarthritis?

Answer 2

Progressive, degenerative

Question 3

When does osteoarthritis typically set in?

Answer 3

Around age 40 and gets progressively worse

Question 4

What 3 things describe osteoarthritis?

Answer 4

• Gradual thinning of cartilage
• Loss of joint space
• Formation of bony spurs

Question 5

What can cause periodic flaring in osteoarthritis?

Answer 5

Inflammation

Question 6

What is the matrix of cartilage formed of?

Answer 6

Chondrocytes

Question 7

What is cartilage mainly composed of?

Answer 7

Type 2 collagen

Question 8

What are type 2 collagen fibres linked by?

Answer 8

Covalent bonds

Question 9

What do the chondrocytes produce in osteoarthritis?

Answer 9

Cytokines and prostaglandins

Question 10

Is the onset of OA sudden or gradual?

Answer 10

Gradual

Question 11

What type of pain is OA? When is this better/worse?

Answer 11

Mechanical pain- worse on activity/end of day, better with rest

Question 12

What may be felt in the joints on movement?

Answer 12

Crepitus

Question 13

How long does stiffness relating to OA last?

Answer 13

Generally < 30 mins

Question 14

What can severe cases of OA cause in joints?

Answer 14

Effusions and soft tissue swellings

Question 15

What are the most commonly affected sites?

Answer 15

Neck, lower back, hips, base of thumbs, ends of fingers, knees, base of big toes

Question 16

OA in unusual sites is usually due to what?

Answer 16

Hobbies/occupation

Question 17

What joints of the hands are affected by OA?

Answer 17

DIP, PIP and 1st CMC (thumb)

Question 18

What are bony enlargements seen at the DIPs known as?

Answer 18

Heberden’s nodes

Question 19

What are bony enlargements seen at the PIPs known as?

Answer 19

Bouchard’s nodes

Question 20

How will joints affected by OA feel?

Answer 20

Hard and lumpy

Question 21

What may be found at the back of the knee?

Answer 21

Baker’s cyst

Question 22

What can a Baker’s cyst sometimes be misdiagnosed as?

Answer 22

DVT

Question 23

Pain from the hip will be felt where?

Answer 23

Groin or radiating to the knee

Question 24

Pain in the hip may actually be coming from where?

Answer 24

Lower back

Question 25

What damage can OA in the cervical spine cause?

Answer 25

Pain and restriction of movement- development of osteophytes may impinge on the spinal cord

Question 26

What damage can OA in the lumbar spine cause?

Answer 26

Osteophytes can cause spinal stenosis if they impinge on the cord

Question 27

What are risk factors for both primary and secondary OA?

Answer 27

Age, female, genetics, obesity

Question 28

What are risk factors for secondary OA only?

Answer 28

Occupation, hobbies, previous injury, joint abnormalities, underlying condition

Question 29

What will blood tests for OA show?

Answer 29

Negative inflammatory markers

Negative auto-antibodies

Question 30

Are x-ray changes of OA always suggestive of symptoms?

Answer 30

No

Question 31

What 4 x-ray changes can be seen in OA?

Answer 31

Loss of joint space
Osteophyte formation
Subchondral cysts
Sclerosis

Question 32

What is sclerosis and how does it look on x-ray?

Answer 32

Hardening of the bone- looks whiter on x-ray

Question 33

Will any drug reverse/cure OA?

Answer 33

No

Question 34

What are some non-pharmacological treatment options for OA?

Answer 34

• Education
• Physiotherapy
• Weight loss
• Footwear and aids

Question 35

What are some pharmacological treatment options for OA?

Answer 35

• Analgesia
• NSAIDs
• Pain modulators
• IA steroids

Question 36

What should you look out for before prescribing NSAIDs?

Answer 36

Any relevant co-morbidities e.g. asthma

Question 37

What are some surgical options for OA?

Answer 37

Washout, soft tissue trimming, joint replacement