Osteoarthritis

Question 1

is it wear and tear or autoimmune condition ?

Answer 1

wear and tear

Question 2

commonly seen in which age group?

Answer 2

elderly

Question 3

typically affected joints?

Answer 3

Large weight bearing joints (hip, knee)
Carpometacarpal joint
DIP, PIP joints

Question 4

Pain following?

improves with?

Answer 4

activity

rest

Question 5

symmetrical or asymmetrical joint pain?

systemic symptoms?

Answer 5

asymmetrical

No

Question 6

X-ray findings?

L
O
S
S

also see what sign in joint space narrowing of erosive OA

Answer 6

Loss of joint space narrowing
Osteophytes forming at joint margins
Subchondral cysts
Subchondral sclerosis

seagull sign

Question 7

• Primary OA ?

- Secondary OA ?

Answer 7

• Primary OA – no underlying cause – increase with age, combination of genetic/environmental factors.
• Secondary OA either congenital (developmental dysplasia of hip) or acquired (fracture, ligamentous injury, neuropathic or metabolic).

Question 8

• Localised disease: features?

- Generalised disease: features?

Answer 8

• Localised disease: usually hip or knee, asymmetrical joint pain over several years.
• Generalised disease: symmetrical, Heberden’s nodes at DIP joints, thumb carpometacarpal joints and knees.

Question 9

• Classic features in OA ?

Answer 9

Herberden’s nodes and Baker’s cyst behind the knee.

Question 10

Management of OA

• lifestyle?
• medication?
• for severe symptoms?
• surgery?

what is the most effective treatment for OA?

Answer 10

Initially, lifestyle advice – weight loss if overweight, regular exercise (improve muscle strength).

Medication

1) paracetamol + topical capsaicin (NSAID)
2) codeine + oral NSAID

severe:
intra-articular steroid injection

surgery:
- Joint replacement – best way to deal with severe OA.

Total joint replacement is the most effective treatment for OA.

Question 11

Is OA - inflam or non-inflam?

Answer 11

non-inflammatory

Question 12

is pain worse in morning or evening?

Answer 12

evening

Question 13

A 57-year-old lady presented to her GP with bilateral knee pain that has been gradually worsening for the past six months. She finally visited her GP because the pain has been causing her significant discomfort and disrupting her daily activities. The pain usually subsides upon resting and usually gets worse in the evening. The lady has a body mass index of 29 kg/m and there are no other significant findings from the history. Upon physical examination, the GP notices some swellings around the finger joints. Taking into account the most likely diagnosis for this patient, which one of the following would be the best initial management plan in accordance with current UK guidelines?

prescribe NSAIDs + advise pt about need for surgery

prescribe regular paracetomal + topical NSAID

educate patient about condition + exercise and weight loss and prescribe paracetamol

Answer 13

educate patient about condition + exercise and weight loss and prescribe paracetamol

diagnosis of osteoarthritis is most likely. This diagnosis is indicated by the patient’s age, gradual onset of pain, resolution of pain on resting and worsening after activity and the swellings around the finger joints (Heberden and Bouchard nodes).

Question 14

Which one of the following X-ray changes is not associated with osteoarthritis?

decreased joint space 
subchondral cysts 
subchondral sclerosis 
osteophytes
periarticular erosions

Answer 14

periarticular erosions

Question 15

A 73-year-old woman who has previously had a total hip replacement (THR) presents for review due to pain on the side of her prosthesis. What is the most common reason that a revision operation would need to be performed in a patient who has had a THR?

aseptic loosening of implant
autoimmune reaction
infection
fracture of implant

Answer 15

aseptic loosening of implant

Aseptic loosening is the most common reason total hip replacements need to be revised

Question 16

A 54-year-old farm worker presents for review. She has recently been diagnosed with osteoarthritis of the hand but has no other past medical history of note. Despite regular paracetamol she is still experiencing considerable pain, especially around the base of both thumbs. What is the most suitable next management step?

add oral diclofenac 
increase paracetomal dose
 add topical ibuprofen 
add oral ibuprofen 
add oral glucosamine

Answer 16

add topical ibuprofen

Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line

Question 17

A 57-year-old man presents to his GP due to pain in his right knee. An x-ray shows osteoarthritis. He has no past medical history of note. What is the most suitable treatment option for the management of his pain?

oral diclofenac
oral ibuprofen
oral paracetamol

Answer 17

oral paracetamol

Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line

Question 18

You are reviewing a patient who is complaining of hip pain. You suspect a diagnosis of osteoarthritis. Which of the following symptoms should prompt further investigations for an alternative diagnosis?

6 month Hx of pain
59 yrs old
hx of developmental dysplasia of hip
morning stiffness lasting 4 hours

Answer 18

morning stiffness lasting 4 hours

Morning stiffness lasting > 2 hours may be an indication of inflammatory arthritis. This would warrant further investigations

Question 19

if it particularly affects thumb - think ?

Answer 19

OA