osteoarthritis Flashcards
what is OA characterised by?
progressive loss of articular cartilage and remodelling of underlying bone due to active response of chondrocytes in articular cartilage and inflammatory cells in surrounding tissues
release of enzymes breaks down collagen and proteoglycans, destroying articular cartilage. exposure of subchondral bone results in scleosis. Get reactive remodelling causing oesteophytes and subchondral bone cysts. joint space is lost over time.
what are the signs of OA on x ray?
subchondral sclerosis
bone cysts
reduced joint space
osteophytes
what are the risk factors of OA?
obesity
age
female
manual labour occupations
what are the clinical features of OA?
- usually affects small joints of hand and foot, also hip and knee
- symptoms are insidious, chronic and gradually worsening
- pain and stiffness made worse with activity and relieved by rest (unlike RA which is made better with activity)
what can be seen on examination with OA?
- inspect for deformity e.g Bouchards nodes (swellings of PIPJ) and Heberden nodes (swelling of DIPJs) in the hand
- can get fixed flexion deformity or varus malalignment in the knees.
- feel for crepitus through range of movement, which is generally reduced and painful.
what are the differential diagnosis on OA?
- inflammatory arthropathies e.g RA
- septic arthiritis
- fractures
- bursitis
- malignancies
what can be done for OA investigations?
x ray
routine bloods to exclude inflammatory or infective cause
how is OA managed conservatively?
educate about condition and progression, as well as advise on joint protection
weight loss
physiotherapy and joint supports
how can OA be managed medically?
- simple analgesia
- topical NSAIDs
- intra articular steroid injections
how can OA be managed surgically?
- osteotomy (bone cutting)
- arthrodesis (joint fusion)
- arthroplasty (joint replacement)
