Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

Osteoarthritis is a degenerative condition characterised by joint pain due to loss of articular cartilage.

Question 2

Describe the pathophysiology of osteoarthritis.

Answer 2

1. Cartilage is damaged - primary wear and tear or secondary eg to obesity.
2. Chrondrocytes respond by producing type 1 collagen which decreases elasticity so there is breakdown of the cartilage matrix.
3. Years later, apoptosis of chondrocytes causes cartilage to flake off into the synovial space, triggering an inflammatory response (synovitis).

Question 3

Give 3 symptoms of OA.

Answer 3

Stiffness: morning lasting <30 mins, end of day.
Pain: burning/sharp ache, worse with prolonged activity.
Tenderness

Question 4

Give 3 signs of osteoarthritis.

Answer 4

X ray: 
Loss of joint space
OSTEOphytes (DIP and PIP)
Subarticular sclerosis
Subchondral cysts

Question 5

What are Heberden’s nodes?

Answer 5

Bony swelling at distal interphalangeal joints

Question 6

What are Bouchard’s nodes?

Answer 6

Bone swelling at proximal interphalangeal joints.

Question 7

Give 3 risk factors of osteoarthritis.

Answer 7

Genetic predisposition, family history
Trauma
Deformities
Obesity
High bone density
Occupation

Question 8

What investigations would you do for suspected OA?

Answer 8

XRay: LOSS signs.
CRP: may be elevated

Question 9

Describe the non-pharmacological management of OA.

Answer 9

Exercise to improve local muscle strength and general aerobic fitness
Weight loss if overweight
Splints
Physiotherapy
TENS

Question 10

Describe the pharmacological management of OA.

Answer 10

Pain and inflammation: Paracetamol and NSAIDs eg ibuprofen
Steroid injections for short term benefit eg methylprednisolone
Hyaluronic acid injections (=viscosupplementation)

Question 11

Describe the surgical management of OA and its indications.

Answer 11

Joint replacement eg hip/knee - if severe OA with substantial impact of QoL.