Osteoarthritis

Question 1

What are the 4 cardinal features of OA?

Answer 1

• Gradual thinning of cartilage
• Loss of joint space
• Formation of bony spurs
• Subchondral sclerosis / cysts

Question 2

Osteoarthritis tends to begin in which decade?

Answer 2

4th

Question 3

The joint cartilage is predominately comprised of which type of collagen?

Answer 3

Type 2

Question 4

Cartilage is formed from which cells

Answer 4

Chondrocytes

Question 5

Which cytokines are involved in OA (4)

Answer 5

• IL-1
• TNF
• Metalloproteases
• Prostaglandins

Question 6

OA is a mechanical pain. It gets worse/better upon activity.

Answer 6

Worse - relieved by rest

Question 7

OA early morning stiffness should last how long?

Answer 7

<30 minutes

Question 8

Inactivity gelling is a hallmark of OA. True/false?

Answer 8

True

Question 9

Describe the cardinal signs of OA (4)

Answer 9

1) Loss of function
2) Bony swellings / effusion
3) Crepitus
4) Stiffness

Question 10

Heberden’s nodes affect which area?

Answer 10

DIPs

Question 11

Bouchards’ nodes affect which area?

Answer 11

PIPs

Question 12

Heberdens/Bouchards nodes are signs of RA. True/false?

Answer 12

False - signs of OA

Question 13

Heberdens/Bouchards nodes will be hot or inflamed typically. True/false?

Answer 13

False

Question 14

How do Heberdens/Bouchards nodes feel upon palpation?

Answer 14

Bony/ solid

Question 15

Genu varus is what deformity?

Answer 15

Barrel-lifting shape

Question 16

Baker’s cyst is not a complication of OA. True/false?

Answer 16

False - it can be caused by OA in the popliteal fossa

Question 17

Describe the risk factors for OA (6)

Answer 17

1) Age
2) Gender (more in women)
3) Occupation (heavy lifting)
4) Previous injury/ joint abnormality (e.g. EDS)
5) Obesity
6) Other conditions e.g. gout, RA

Question 18

In OA, ESR and CRP are raised. True/false?

Answer 18

False - these are raised in RA

Question 19

A soft/warm/tender joint indicates OA. True/false?

Answer 19

False - this is RA

Question 20

What are the primary joints affected in OA versus RA?

Answer 20

OA: 
-DIPs
-Carpometacarpal
RA:
-MCPs
-PIPs

Question 21

Surgical options to treat OA include (3)

Answer 21

• Arthroscopic washout
• Loose body trimming
• Joint replacement

Question 22

In a primary care setting, list some reasons for referral of OA patients for secondary treatment (5)

Answer 22

• Pain is severe (especially at night)
• Loss of function
• Support at home needed
• Age (patient older)
• Diagnostic uncertainity

Question 23

OA gives a X-type of pain. What are the features of this pain type?

Answer 23

X = mechanical.

Worse on activity, relieved by rest.

Question 24

In OA, how long does the morning stiffness last?

Answer 24

Usually <30 minutes

Question 25

OA can give parasthesia, T/F?

Answer 25

True - due to impingement of the spinal nerves

Question 26

How do OA joints feel compare to RA joints?

Answer 26

OA- bony and hard. RA - soft, warm and tender.

Question 27

How is OA managed (non-pharmacological)?

Answer 27

Education, physiotherapy, weight loss, footwear changes, appropriate aids (e.g. walking stick)

Question 28

How is OA managed pharmacologically?

Answer 28

Analgesia (paracetamol; topical or PO), NSAIDs long-term if risk: benefits considered, pain modulators (e.g. gabapentin, amitryptyline), IA steroids, opioids if severe pain