Osteoarthritis

Question 1

What is osteoarthritis

Answer 1

a degenerative disorder which occurs as the result of imbalance between wear and repair of cartilage within joints.

Question 2

Difference between primary and secondary OA

Answer 2

primary - no identifiable cause

secondary - previous injuries, or known attributable cause

Question 3

Causes of secondary OA

Answer 3

congenital dislocation of the hip 
Perthes
SUFE
Previous intra-articular #
Extra-articular # with malunion 
Osteochondral/hyaline cartilage injury 
Crystal arthropathy 
inflammatory arthritis 
meniscal tears 
genu valgum or varus

Question 4

Characteristic appearance of OA on xray

Answer 4

LOSS signs

Loss of joint space

Osteophyte formation

Sclerosis

Subchondral cysts

Question 5

what causes subchondral cysts in OA

Answer 5

occurs when there is no cartilage left - the synovial fluid in the joint space goes into the bone and forms cysts

Question 6

What are osteophytes and what causes them in OA

Answer 6

Attempted repair of bone by osteoblasts

Question 7

Presentation of OA

Answer 7

Mechanical PAIN

• worse on activity
• relieved by rest

STIFFNESS

• worse in the morning
• lasts < 30 mins

Signs- crepitus, bony enlargements

Question 8

Commonly involved joints in OA

Answer 8

knee
hip
hand
spine

Question 9

is OA more commonly unilateral or bilateral joint involvement

Answer 9

unilateral joint involvement

Question 10

what is sclerosis in OA and how does it appear on xray

Answer 10

hardening of the bone

looks more white!

Question 11

What joints in the hands are affected in OA

Answer 11

DIP, PIP and 1st CMC joints

Question 12

Bouchards nodes

Answer 12

bony enlargements in the PIP joints

Question 13

Heberden’s nodes

Answer 13

bony enlargements in the DIP joints

Question 14

How does OA in the knee present

Answer 14

Osteophytes
Effusions
Crepitus 
Restriction of movement 
Genu valgum and varum

Question 15

How does OA in the hip present

Answer 15

pain in the groin or radiating to the knee

Question 16

Most common region of spine to be affected by OA

Answer 16

cervical spine

Question 17

how does OA in the spine present

Answer 17

pain

can impinge on nerve roots

Question 18

Tx of OA

Answer 18

Non-pharmacological: physio, weight loss, exercise, walking stick

1. local analgesias (topical NSAIDs) - only if knee or hand
2. • paracetamol
     3 + oral NSAIDs
3. • intra-articular corticosteroid injections
4. • intra-articular hyaluronic acid injections
5. • opioids
6. • pain modulators (SSRI e.g.)

then joint replacement surgery