Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

• It is the most common joint condition worldwide
• It mostly affects over 60s
• It is usually primary but may be secondary to joint disease or other conditions (haemochromotosis, obesity, occupational)

Question 2

What is localised osteoarthritis?

Answer 2

When it affects the knee or hip

Question 3

What is generalised osteoarthritis?

Answer 3

• It is known as nodal OA
• Joints affected include:
  
  • DIP
  • PIP
  • CMC joints
    
    • Carpal (wrist) bone and Metacarpal (long bone of the thumb),
  • Knees in post-menopausal females

Question 4

What are the signs and symptoms of localised disease?

Answer 4

• Crepitus and pain on movement
  
  • Worse with prolonged activity
• Background ache at rest
• Brief stiffness at rest (Joints may ‘gel’)
  
  • Usually 10-15 mins or so
• Joints feel unstable with a percieved lack of power due to pain

Question 5

What are the signs and symptoms of generalised disease?

Answer 5

• Joint tenderness
• Derangement
• Bony swelling
• Reduced range of movement
• Mild synovitis
• Assess effect of symptoms on occupation, family duties, hobbies and lifestyle expectations

Question 6

What tests should be carried out for osteoarthritis?

Answer 6

• Plain radiographs
  
  • LOSS
    
    • Loss of joint space
    • Osteophytes
    • Subchondral cysts
    • Subarticular sclerosis
• CRP may be elevated

Question 7

How is osteoarthritis managed?

Answer 7

• Core treatments
  
  • Exercise to improve local muscle strength
  • Weight loss if overweight
• Analgesia
  
  • Paracetamol and topical NSAIDs
  • Codeine or short term oral NSAIDs (+PPI)
  • Topical casaicin may help
  • Intra-articular steroid injections
    
    • These temporarily relieve pain in severe symptoms
• Non-pharmacological
  
  • Therapists
  • Occupational therapists
  • Heat or cold packs at site of pain
  • Walking aids
  • Stretching
• Surgery
  
  • Joint replacement