Osteoarthritis

Question 1

How common is it?

Answer 1

Osteoarthritis affects >50% of the >60 population in the UK

Question 2

What are the types of osteoarthritis?

Answer 2

Primary - Microtrauma over a long period

Secondary - A single acute trauma

Question 3

What biomechanical factors presdispose to osteoarthritis?

Answer 3

• Abnormal anatomy e.g. DDH
• Intra-articular fracture
• Ligament rupture
• Meniscal injuries
• Occupation e.g .farmers and footballers
• Persistent heavy activity e.g. running
• Obesity

Question 4

Describe the pathogenesis of Osteoarthritis?

Answer 4

Trauma &mechanical imbalance
-> Damaged joint
-> Inflammation & pain
-> Synovial hypertrophy -> Joint effusion
+ Subchondral changes -> Uneven articular surface

Along with the repair processes around the joint you end up with a persistently inflamed and imbalanced joint

Question 5

Describe the presentation of Osteoarthritis?

Answer 5

• 45yrs plus
• with activity related joint pain (most often in hip or knee)
• • Restriction of function

Important: None or >30mins of early morning stiffness (otherwise points to other arthritidis)

Question 6

Where does the pain of OA appear?

Answer 6

Hip OA - Groin pain +/-radiation down thigh to knee

Knee OA - Pain in ant knee

Question 7

Some presentations that are unlikely to be OA:

Answer 7

LArge trauma
Prolonged early morning stiffness
Rapidly deteriorating symptoms
Hot and/or swollen joint

Question 8

DDX for OA?

Answer 8

Gout
Inflammatory Arthritidis e.g. RA
Septic ARthritis
Malignancy

Question 9

How do diagnose OA?

Answer 9

Clinically, but if unusual do:

• X-ray
• CRP/ESR

Question 10

How do we manage OA (in short)?

Answer 10

In this order:

• Self management and holistic care
• Exercise and weight loss
• Non-pharmacological therapies
• Pharmalogical treatment
• Surgery

Question 11

Describe the parts of OA self-management?

Answer 11

Thermotherapy i.e. heat/ice
Rest or changed activity
OTC painkillers

Question 12

Describe the importance of OA holistic care?

Answer 12

Most cases are dealt without meds/surgery.
Need to address the patient's:
- Depression
- Ability to work
- Family roles
- Social isolation
- Daily living/hobbies

Question 13

What non-pharmacological therapies can we offer for OA?

Answer 13

Thermotherapy
Electrotherapy (TENS)
Aids/devices e.g. walking stick
MAnual Therapy e.g. Physio

Question 14

What pharmacological therapies can we offer for OA?

Answer 14

ORal Analgesia e.g. paracetamol or NSAIDs
Topical e.g. NSAIDS or Capsaicin cream
Intra-articular injections: steroids (hyaluronic acid)

Question 15

When would we refer OA for surgery?

Answer 15

• Substantial impact on QOL

- Or Refractory to other treatments

Question 16

What surgery can we do for OA?

Answer 16

Joint Replacement

Question 17

What would you see on XRAY?

Answer 17

LOSS

• loss of joint space
• Osteophytes
• Subarticular sclerosis
• Subchondral cysts