Osteoarthritis

Question 1

How common is osteoarthritis?

Answer 1

Most common joint problem in the UK Symptoms affect more than half the UK population over 60

Question 2

What is osteoarthritis?

Answer 2

Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone

Question 3

Can we cure osteoarthritis?

Answer 3

No - merely symptom management

Question 4

Who manages osteoarthritis?

Answer 4

Physicians, nurses, physiotherapists, dieticians, GPs, patients, OTs, orthopaedic surgeons

Question 5

What is the definition of osteoarthritis?

Answer 5

Tear, flare and repair

Question 6

What is the pathogenesis of osteoarthritis?

Answer 6

Tear = trauma to the joint, which results in inflammation and then pain and then resolution causing loss of function

• Trauma and mechanical imbalance
• Inflammation and pain
• Repair processes around joint

Question 7

What causes the tear/trauma?

Answer 7

• Abnormal anatomy
• Intra-articular fracture [fracture around knee]
• Ligament rupture and meniscal injury result in imbalance [these normally protect against osteoarthritis]
• Occupational: farmers, footballers [repetitive trauma to joint]
• Elite running
• Obesity

Question 8

What is the process of inflammation?

Answer 8

• Synovial hypertrophy [excess joint fluid]
• Subchondral changes [cause uneven surface]
• Joint effusion

Question 9

What are the associated blood markers?

Answer 9

IL-1𝝱, TNF 𝜶, MMPs

Question 10

What is the pathway of pathogenesis?

Answer 10

[this excludes acute trauma]

Question 11

What are common complaints from pateints with OA?

Answer 11

• Pain on movement
• Restricted movement
• Pain on specific joint
• On vast majority of complaints from the knee it is actually the hip: groin pain is most common complaint from hip, this pain will move down to the knee
• Knee arthritic pain: generally on the knee
• Stiffness (osteoarthritis – temporary)

Question 12

What is a useful question to determine if it is hip OA?

Answer 12

Can you bend down to put on your shoes/tie your laces?

Question 13

What are common signs and symptoms for diagnosis?

Answer 13

• Over 45
• Activity related joint pain plus
• no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes

Question 14

What are some non osteoarthritic symptoms?

Answer 14

• Trauma
• Prolonged morning stiffness
• Rapid deterioration of symptoms
• Hot, swollen joint = infection

Question 15

What are some DDx?

Answer 15

• Gout
• Other inflammatory arthritides
• Septic arthritis
• Malignancy

Question 16

What is the first line of management?

Answer 16

Conservative management and self care: analgesics (NSAIDS, combine with paracetamol – morphine based are unattractive because SE, thermotherapy is useful, rest is useful)

Question 17

What is the nice guidelines for osteoarthritis management?

Answer 17

Question 18

What are some non-pharmacological treatments of osteoarthritis?

Answer 18

• Thermotherapy
• Electrotherapy (not commonly used)
• Aids/Devices: walking stick, wheelchair
• Manual therapy (physio). Improve muscle strength around joint

Question 19

What is the mainstay of pharmacological treatments for osteoarthritis?

Answer 19

• Oral analgesia: paracetamol, NSAIDS
• Topical treatments: NSAIDS, capsaicun

Question 20

When do we refer to surgery?

Answer 20

When all non-pharmaceutical/pharmaceutical options are non-effective.

Question 21

What do we need to mention in referral letter?

Answer 21

• Include timeframe, options explored, management attempted, BMI, do X-ray pre referral

Question 22

What can be seen on this Xray?

Answer 22

• Left image: osteophytes can be seen (this is excess bone)
• Loss of joint space
• Cyst formation
• Subchondral sclerosis

Question 23

What is the fundamental reason for a hip replacement?

Answer 23

Pain

Question 24

What can be seen on this image of the knee?

Answer 24

[in circled area] cartilage has completley worn away