Osteoarthritis

Question 1

Epidemiology of OA

Answer 1

Osteoarthritis affects >50% of the >60 population in the UK

Question 2

What are the types of osteoarthritis? [2]

Answer 2

Primary - Microtrauma over a long period

Secondary - A single acute trauma

Question 3

What biomechanics factors presdispose to osteoarthritis? [6]
Secondary [2]
Primary [4]

Answer 3

Secondary

• Intra-articular fracture
• Ligament rupture & meniscal injuries

Primary

• Abnormal anatomy e.g. DDH
• Occupation e.g .farmers and footballers
• Persistent heavy activity e.g. running
• Obesity

Question 4

Describe the pathogenesis of Osteoarthritis? [4]

Answer 4

Risk factors lead to increased load -> Joint micro trauma
-> Inflammation & pain
-> Synovial hypertrophy -> Joint effusion
+ Subchondral changes -> uneven articular surface

Question 5

Describe the presentation of Osteoarthritis? [3]

Answer 5

45+ yo
Activity related joint pain and
No morning joint stiffness (this is RA picture) or morning joint stiffness lasting no longer than 30 minutes

Question 6

Where does the pain of OA appear? [2]

Answer 6

Hip OA - Groin pain +/-radiation down thigh to knee

Knee OA - Pain in ant knee

Question 7

Red flags OA [4]

Answer 7

Large trauma
Prolonged early morning stiffness
Rapidly deteriorating symptoms
Hot and/or swollen joint

Question 8

DDX for OA? [4]

Answer 8

Gout
Septic arthritis e.g. RA
Malignancy
Other inflammatory arthritides

Question 9

How to diagnose OA? [2]

Answer 9

Clinically, but if unusual do:

• X-ray
• CRP/ESR

Question 10

Stepwise approach to OA management [5]

Answer 10

In this order:
Self management and holistic care eg ADLs
Exercise and weight loss
Non-pharmacological therapies [4]
Rx: Analgesia & Topical treatments
Surgery

Question 11

Describe the parts of OA self-management? [3]

Answer 11

Thermotherapy - cold compress
Rest or changed activity, change occupation
OTC painkillers

Question 12

Describe the importance of OA holistic care?

Answer 12

Most cases are dealt without meds/surgery.
Need to address the patient's:
- Depression
- Ability to work
- Family roles
- Social isolation
- Daily living/hobbies

Question 13

What non-pharmacological therapies can we offer for OA? [3]

Answer 13

Electrotherapy (TENS)
Aids/devices e.g. walking stick
Manual Therapy e.g. Physio

Question 14

What pharmacological therapies can we offer for OA? [3]

Answer 14

Oral Analgesia e.g. paracetamol or NSAIDs
Topical e.g. NSAIDS or Capsaicin cream
Gastroprotection

Question 15

When would we refer OA for surgery? [2]

Answer 15

• Substantial impact on QOL

- Or refractory to other treatments

Question 16

What surgery can we do for OA? [1]

Name instrumental therapies for OA [2]

Answer 16

Joint Replacement

Intra-articular hyaluronic acid and corticosteroid injections

Question 17

X-ray changes of osteoarthritis LOSS

Answer 17

Loss of joint space
osteophytes forming at joint margins
subchondral sclerosis
subchondral cysts