Osteoarthritis

Question 1

Risk factors for OA

Answer 1

Age 
Female
Trauma
Obesity
Genetics

Question 2

Clinical Features of OA

Answer 2

Pain and loss of function
PIP and DIP
Morning stiffness <30mins
Bone osteophytes - Bouchard and Heberden nodes
Assymetrical joint-space narrowing
Older patients >40yo

Foraminal stenosis can occur as a result of OA

Question 3

Affected Joints in Primary OA

Answer 3

PIP and DIP
CMC (carpometacapral)
Hip
Knee

Question 4

DSIH (Diffuse Idiopathic Skeletal Hyperostosis)

Answer 4

Calcification of spinal ligaments –> multiple osteophytes

T/Sp most involved

Calcification at the enthesis - bone spurs (achilles and calcaneal)

Dx: 4 osteophytes in 4 contiguous vertebrae

(different to AS - as there is NO vertical syndesmophytes that bridge vertebrae together)

Question 5

XR findings of OA

Answer 5

Joint Space Narrowing
Osteophytes
Subchondral Sclerosis
Bone cyst formation
Eburnation (deformation of the joint surface)

Question 6

Management

Answer 6

Diet
Weight Loss
Exercise + Hydrotherapy

Physiotherapy
Mobility Aid

Pharmacotherapy:
Paracetamol
NSAIDs - or COX2 - safer from GI bleed perspective
Opioids

?Corticosteroid injection

Hyaluronic acid Injection

Joint replacement - TKR or THR
- indicated when pain and loss of function impact on quality of life