Osteoarthritis

Question 1

Describe osteoarthritis?

Answer 1

• Most common arthritis
• Weight bearing joints of older people
• Can be secondary to another condition
  
  • eg haemachromatosis, obesity, occupational

Question 2

What is OA characterised by?

Answer 2

• Focal loss of articular cartilage
• Subchondral sclerosis
• Osteophyte formation
• Enlargement of affected joints

Question 3

Name some risk factors for osteoarthritis?

Answer 3

• Obesity
• Genetics
• Repetitive loading
• Adverse biomechanics
  
  • Mensicetomy, Paget’s disease

Question 4

Describe the signs and symptoms of OA?

Answer 4

• Local disease
  
  • Often knee or hip
  • Pain & crepitus on movement, background ache at rest
• Generalised disease
  
  • Nodal OA (typically DIP, PIP, CMC, knee joints)
  • Joint tenderness, derangement and bony swelling
    
    • Heberden’s at DIP, Bouchard’s at PIP
  • Reduced ROM and mild synovitis

Question 5

Describe the tests for OA?

Answer 5

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

Question 6

Describe the management of osteoarthritis?

Answer 6

• Weight loss, strength/aerobic exercises, shock absorbing footwear
• Physiotherapist, occupational therapist involvement
• Heat/cold packs, TENS
• NSAIDs, opiates, amitriptyline, gabapentin
• Intra-articular glucocorticoid injections
• Joint replacement

Question 7

What is pictured here?

Answer 7

Heberden’s nodes of DIP in OA

Question 8

Describe the composition of joint aspiration in normal circumstances?

Answer 8

• Clear, colourless
• WBC =<200
• No neutrophils

Question 9

Describe the composition of joint aspiration in osteoarthritis?

Answer 9

• Clear, straw-coloured
• Increased viscosity
• WBC =<1000
• Neutrophils =<50%

Question 10

What is the defining feature of OA?

Answer 10

Degeneration of articular cartilage

Question 11

What is the general distribution of OA?

Answer 11

• Hips, knees
• PIP, DIP
• Neck
• Lumbar spine

Question 12

Describe the pain associated with OA?

Answer 12

• Insiduous onset over a long time
• Related to movement and weight bearing
  
  • Relieved by rest
• Only brief morning sitffness

Question 13

Clinical signs of OA?

Answer 13

• Restricted movement
• Palpable crepitations of joint
• Bone swelling, deformity
• Muscle weakness

Question 14

What causes the restricted joint movement in RA?

Answer 14

• Capsular thickening
• Blockage by osteophyte

Question 15

Describe the features of Generalised nodal OA?

Answer 15

• Polyarticular IP joint OA
• Heberden’s +/- Bouchards nodes
• Mostly females
• Strong genetic predisposition

Question 16

How can you differentiate between Heberden’s and Bouchard’s nodes?

Answer 16

• Heberden’s
  
  • DIP nodes
• Bouchard’s
  
  • PIP nodes

Question 17

Radiological appearance of OA in the hands

Answer 17

Question 18

Where does OA have the greatest effect within the knee joint?

Answer 18

• Patello-femoral compartment
  
  • Pain worse when using stairs
• Tibio-femoral compartment

Question 19

What knee deformity can OA cause?

Answer 19

Varus deformity

Question 20

Where does OA most commonly occur within the hip joint?

Answer 20

Superior joint aspect

Question 21

What does posterior knee pain in OA signify?

Answer 21

Complicating popliteal (Baker’s) cyst

Question 22

Where in the spine is OA most likely to affect?

Answer 22

Cervical and lumbar spine

Question 23

How does spine OA normally present?

Answer 23

• Pain in lower back region
• Relieved by rest, worse on movement
• Straight leg test positive