Osteoarthritis Flashcards
How common is it?
Osteoarthritis affects >50% of the >60 population in the UK
What are the types of osteoarthritis?
Primary - Microtrauma over a long period
Secondary - A single acute trauma
What factors presdispose to osteoarthritis?
- Abnormal anatomy e.g. DDH
- Intra-articular fracture
- Ligament rupture
- Meniscal injuries
- Occupation e.g .farmers and footballers
- Persistent heavy activity e.g. running
- Obesity
Describe the pathogenesis of Osteoarthritis?
Trauma & mechanial imbalance
-> Damaged joint
-> Inflammation & pain
-> Synovial hypertrophy -> Joiny effusion
+ Subchondral changes -> Uneven articular surface
Along with the repair processes around the joint you end up with a persistently inflamed and imbalanced joint
Describe the presentation of Osteoarthritis?
45yrs plus with activity related joint pain (most often in hip or knee) + Restriction of function
Important: None or >30mins of early morning stiffness (otherwise points to other arthritidis)
Where does the pain of OA appear?
Hip OA - Groin pain +/-radiation down thigh to knee
Knee OA - Pain in ant knee
Some presentations that are unlikely to be OA:
LArge trauma
Prolonged early morning stiffness
Rapidly deteriorating symptoms
Hot and/or swollen joint
DDX for OA?
Gout
Inflammatory Arthritidis e.g. RA
Septic ARthritis
Malignancy
How do diagnose OA?
Clinically, but if unusual do:
- X-ray
- CRP/ESR
How do we manage OA (in short)?
In this order: Self management and holistic care Exercise and weight loss Non-pharmacological therapies Analgesia & Topical treatments Surgery
Describe the parts of OA self-management?
Thermotherapy i.e. heat/ice
Rest or changed activity
OTC painkillers
Describe the importance of OA holistic care?
Most cases are dealt without meds/surgery. Need to address the patient's: - Depression - Ability to work - Family roles - Social isolation - Daily living/hobbies
What non-pharmacological therapies can we offer for OA?
Thermotherapy
Electrotherapy (TENS)
Aids/devices e.g. walking stick
MAnual Therapy e.g. Physio
What pharmacological therapies can we offer for OA?
ORal Analgesia e.g. paracetamol or NSAIDs
Topical e.g. NSAIDS or Capsaicin cream
When would we refer OA for surgery?
- Substantial impact on QOL
- Or Refractory to other treatments