osteoarthritis Flashcards
algorithm treatment for OA
education, lifestyle topical nsaid, paracetamol oral NSAID substitute analgesia add gabapentin/ amitryptilene -consider tramadol& paracetamol -strong opiates instead of tramadol
4 main signs of OA on a radiograph
joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes
risk factors for OA 10
repetitive adverse loading congenital abnormalities paget obesity sex hormones hereditary age trauma joint shape alignment
2 causes of OA
primary: idiopathic no identifiable cause (RF)
secondary: clear cause eg trauma, infection, development, pathology
pathophysiology of OA
damage to cartilage chondrocytes compensate fail to compensate aggrecan in matrix falls vulnerable to injury fibrillation- chondrocyte death crystals deposited in cartilage water content increases osteophyte formation bone remodelling synovium hyperplasia muscle wasting
symptoms of OA
- functional restriction
- pain
- insidious onset over months/yr
- intermittent
- pain mostly on movement
- relieved by rest
- morning stiffness <30 mins
- usually only one or a few joints
- night pain
clinical signs of OA
loss of internal rotation and fixed flexion
restricted movement due to capsular thickening
palpable, coarse crepitus
bony swelling around margin
deformity
periarticular tenderness
muscle weakness/ wasting
generalised nodal OA characteristics
IPJ OA polyarticular herbeden and Bouchard female middle age predispose to knee OA genetic predisposition pain/ asymptomatic postlateral swelling episodic as nodes develop common 1st cmcpj joint
knee OA common sites
patello-femoral and medial tibio-femoral compartments
knee OA symptoms
varus deformity women=bilateral men=trauma unilateral pain medial aspect patello pain going up stairs Baker's cysts
Knee OA features on exam
jerky, antalgic gait varus/ fixed flexion deformity joint line tenderness wasting quads restricted flexion bony swelling joint line
Hip OA 2 types
superior lateral: freq progress with superolateral migration of femoral head
medial: less common, bilateral, assoc. to generalised, better prognosis
hip OA symptoms
deep anterior groin pain thigh pain lateral hip pain tenderness of greater trochanter restricted flexion, extension,and hip abduction
hip OA examination
antalgic gait waste quads ant groin tenderness restriction/ pain on IR fixed flexion, ER deformity ipsilateral leg shortening superior femoral migration
OA hip grading 0-4
0=no radiographic features
1=poss jsn and subtle osteophytes
2=definite JSN, defined osteophytes, some sclerosis
3=marked JSN, small osteophytes, some sclerosis & cyst form, deformity femoral head/ acetabulum
4=gross JSN, large osteophytes and increased deformity of femoral head and acetabulum
early onset OA name and ages
kashin beck rare 7-13
causes of early onset OA
mono=previous trauma
poly=juvenille idiopathic arthritis, metabolic (haemachromatosis, onchronosis, acromegaly), spondyolo epiphyseal dysplasia, late AVN, neuropathic, Kashin beck
what is erosive OA
rare patients with hand OA with prolonged symptoms
target PIPJ
investigation for OA
x-ray weight bearing for knees/ non for hip
MRI spine
FBC
working dx of OA can be made without an xray if…
> 45 years
chronic joint pain >3 months
morning stiffness >30mins
other treatments for OA
-intra-articular steroids
-TENS and accupuncture
-chondroitin sulphate and glucosamine sulphate
-surgery
arthroplasty, arthrodesis, osteotomy
normal structure and function of articular/hyaline cartilage
- Articular cartilage
o Connective tissue
o Made of chondrocytes bound in a extracellular matrix
o Avascular and nourished via synovial fluid
o Function
Structure
Load bearing : deep with perpendicular fibres
Reduce friction : superficial with parallel collagen fibres and few chondrocytes
contents of articular cartilage
- Hyaline articular cartilage o Extracellular matrix 65-80% water by mass Type 2 collagen Proteoglycans o Chondrocytes Produces ecm and enzymes
what does OA do to articular cartilage
- OA
o Increases water content which reduces number of cells eg loose chondrocytes so lose cartilage
o Results in inferior load bearing and increased friction
what joints does oa most commonly affect
dip and pip
carpometacarpal joints
large joints
typical history of OA
pain following use
improves with rest
unilateral symptoms- unsymmetrical
no systemic upset
