Osteoarthritis Flashcards
What is osteoarthritis (OA)?
Articular cartilage thinning or loss
=> bones rub together
=> pain in joints
Why is ageing a risk factor for OA?
more “wear and tear” over your lifetime
What are the risk factors for developing OA?
Age Female Obesity Previous injury Muscle weakness Proprioceptive deficits Genetics Acromegaly (excess growth hormone) Joint inflammation Crystal deposition
What types of OA exist?
IDIOPATHIC
-no known cause
SECONDARY
- Previous injury
- Calcium crystal deposition
- Rheumatoid arthritis `
Describe the anatomical distribution of joints affected in OA
Hand Cervical spine Lumbar spine Hip Knee Foot (MTP joints)
What are the typical symptoms of OA?
Pain – worse on activity and relieved by rest.
May progress to be present with less activity and at rest or at night
Stiffness – usually morning stiffness lasts less than 30 mins
What can be seen or palpated on examination of osteoarthritic joints?
Crepitus
Joint swelling -Bony enlargements due to osteophytes
Joint tenderness
Joint effusion
What clinical features of OA are specific to the hands?
Bony enlargements at:
- DIPs (Heberdens nodes)
- PIPs (Bouchards nodes)
Squaring of the hand
What clinical features of OA can be present in the knee?
Osteophytes
effusions
crepitus
restriction of movement
Genu varus or valgus deformities
Bakers cyst
Where would OA pain in the hip potentially radiate to?
Pain may be felt in groin or radiating to knee
Pain felt in hip may be radiating from the lower back
What clinical features can be present in the spine?
Cervical – pain and restriction of neck movement
Lumbar – Pain on standing or walking for some time.
osteophytes can cause spinal stenosis if encroach on spinal canal or pinch the nerve root
What acronym is used to analyse an X-Ray in suspected OA
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
(LOSS)
Describe the different Kellgren-Lawrence grading levels of OA
Grade 0 - No radiographic findings of osteoarthritis
Grade 1 - Minute osteophytes of doubtful clinical significance
Grade 2 - Definite osteophytes with unimpaired joint space
Grade 3 - Definite osteophytes with moderate joint space narrowing
Grade 4 - Definite osteophytes with severe joint space narrowing and subchondral sclerosis
What non-pharmacological management is often used in OA
Physiotherapy- muscle strengthening, proprioceptive
‘Common sense measures’ - weight loss exercise, trainers, walking stick, insoles
What pharmacological management is often used in OA
Analgesia – paracetamol, compound analgesics, topicals
NSAIDs - topical/systemic
Pain modulators
- tricyclics eg. amitriptyline
- anti-convulsants eg. Gabapentin
Intra-articular – Steroids, Hyaluronic acid
