Osteoarthritis

Question 1

What is osteoarthritis defined as

Answer 1

Tear, flare and repair

• trauma and mechanical imbalance
• inflammation and pain
• repair process around the joint

Question 2

biomechanical factors which predispose to OA

Answer 2

Abnormal Anatomy - developmental problems
Intra-Articular Fracture - tibial plateau fractures leave a small residual gap
Ligament Rupture - results in imbalance
Meniscal Injury - results in imbalance
Persistent heavy activity
Sports
Obesity

Question 3

How does inflammation of the joint lead to pathology

Answer 3

Inflammation of the synovial capsule causes hypertrophy.
This causes pressure which results in subchondral changes.
This predisposes the articular surface to becoming uneven leading to joint effusion

Question 4

What becomes elevated as a result of an osteoarthritic jont

Answer 4

IL-1, TNFa, MMP

Question 5

Diagnosis of OA

Answer 5

45+
Activity-related joint pain PLUS either :
- no morning joint-related stiffness
- morning stiffness which lasts no longer than 30 mins

Question 6

Which presentations are unlikely to be OA

Answer 6

Associated trauma
Prolonged morning-related stiffness
Rapid deterioration of symptoms
Hot, swollen joint

Question 7

Ddx for OA

Answer 7

Gout
Septic arthritis
Malignancy

Question 8

Self-Management of OA

Answer 8

Painkillers

• Anti-inflammatories (gastric SE if prolonged, exacerbates asthma)
• Paracetamol
• Morphine based (many SE)

Rest
Lose Weight
Exercise

Question 9

Non-pharmacological treatments

Answer 9

Thermotherapy
Electrotherapy
Aids and Devices (sticks, support bandages)
Manual Therapy - physio

Question 10

Examples of physiotherapy treatment

Answer 10

Improving range of movement
Muscle strengthening exercises
- quads for knee pain
- core for lower back pain

Question 11

Pharmacological treatments

Answer 11

Oral analgesics - paracetamol, NSAIDs

Topical - NSAIDs, capsaicin (knee, hand)

Question 12

When should a surgical referral be made

Answer 12

Substantial impact on QoL
Refractory to non-surgical treatment
Bone on bone

Question 13

What may be seen on an x-ray of an osteoarthritic hip

Answer 13

Osteophites - excess bone along joint (may be attempt to strengthen joint by increasing surface area)
Loss of joint space

Subchondral Sclerosis - increased density of bone (brighter white)

Subchondral Cyst

Narrowing of joint space

(joint erosions)