Osteoarthritis Flashcards
What was osteoarthritis traditionally thought of as?
Wear and tear of joints with age
What is the pathogenesis of osteoarthritis?
degradation of cartilage and remodelling of bone due to active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissue, this causes release of enzymes which break down collagen and proteoglycans, destroying the articular carriage, the exposure of subchondral bone causes sclerosis, reactive remodelling, osteophytes and bone cysts, joint space narrowing
What are the 4 signs of osteroarthritis on an x-ray?
Loss of joint space, osteophytes, subchondral cysts, subchondral sclerosis
What are the risk factors for osteoarthritis?
Obesity, advancing age, female gender, manual labour
What joints are most commonly affected in osteoarthritis?
small joints of the hands and fingers, hip joint, knee joint
What do the symptoms of osteoarthritis usually present like?
Insidious, chronic and gradually worsening, pain and stiffness in the joints which is worse with activity and relieved by rest, gets worse throughout the day but stiffness improves, deformity and reduced range of movement
On examination of osteoarthritis what can be seen?
Bouchards nodes (swelling of the PIPJs) or Heberdens nodes (swelling of the DIPJ) in the hands or fixed flexion deformity or various malalignment in the knees, crepitus, reduced movement and painful
What are the differential diagnosis for osteoarthritis?
Rheumatoid arthritis, gout, CPPD, septic arthritis, fractures, bursitis, malignancy
What are the differential diagnosis for osteoarthritis in the hand?
De quervains tenosynovitis, RA, gout
What are the differential diagnosis for osteoarthritis in the hip?
Trochanteric bursitis, radiculopathy, spinal stenosis, iliotibial band syndrome
What are the differential diagnosis for osteoarthritis in the knee?
Referred hip pain, meniscal or ligament tears or chondromalacia patellae
What investigations are done for osteoarthritis?
Clinical diagnosis, to exclude other diagnosis can do route bloods to exclude an inflammatory to infective cause, radiographs are used to confirm diagnosis
What is the conservative management for osteoarthritis?
education about the condition and progression, strengthening exercises, weight loss, heat or ice packs, joint support, physiotherapy
What is the medical management for osteoarthritis?
Simple analgesics, topical NSAIDs, intra-articular steroid injections (mixed with local anaesthetic due to steroid flare)
What is the surgical management for osteoarthritis?
Osteotomy, Arthrodesis (joint effusion), Arthroplasty
