Osteoarthritis Flashcards
Describe osteoarthritis?
- Most common arthritis
- Weight bearing joints of older people
- Can be secondary to another condition
- eg haemachromatosis, obesity, occupational
What is OA characterised by?
- Focal loss of articular cartilage
- Subchondral sclerosis
- Osteophyte formation
- Enlargement of affected joints
Name some risk factors for osteoarthritis?
- Obesity
- Genetics
- Repetitive loading
- Adverse biomechanics
- Mensicetomy, Paget’s disease
Describe the signs and symptoms of OA?
- 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
Describe the tests for OA?
- Plain radiographs: LOSS
- Loss of joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cysts
- CRP may be slightly elevated
Describe the management of osteoarthritis?
- 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
What is pictured here?
Heberden’s nodes of DIP in OA
Describe the composition of joint aspiration in normal circumstances?
- Clear, colourless
- WBC =<200
- No neutrophils
Describe the composition of joint aspiration in osteoarthritis?
- Clear, straw-coloured
- Increased viscosity
- WBC =<1000
- Neutrophils =<50%
What is the defining feature of OA?
Degeneration of articular cartilage
What is the general distribution of OA?
- Hips, knees
- PIP, DIP
- Neck
- Lumbar spine
Describe the pain associated with OA?
- Insiduous onset over a long time
- Related to movement and weight bearing
- Relieved by rest
- Only brief morning sitffness
Clinical signs of OA?
- Restricted movement
- Palpable crepitations of joint
- Bone swelling, deformity
- Muscle weakness
What causes the restricted joint movement in RA?
- Capsular thickening
- Blockage by osteophyte
Describe the features of Generalised nodal OA?
- Polyarticular IP joint OA
- Heberden’s +/- Bouchards nodes
- Mostly females
- Strong genetic predisposition
How can you differentiate between Heberden’s and Bouchard’s nodes?
- Heberden’s
- DIP nodes
- Bouchard’s
- PIP nodes
Radiological appearance of OA in the hands
Where does OA have the greatest effect within the knee joint?
- Patello-femoral compartment
- Pain worse when using stairs
- Tibio-femoral compartment
What knee deformity can OA cause?
Varus deformity
Where does OA most commonly occur within the hip joint?
Superior joint aspect
What does posterior knee pain in OA signify?
Complicating popliteal (Baker’s) cyst
Where in the spine is OA most likely to affect?
Cervical and lumbar spine
How does spine OA normally present?
- Pain in lower back region
- Relieved by rest, worse on movement
- Straight leg test positive
