Osteoarthritis

Question 1

Define osteoarthritis

Answer 1

Age-related degenerative joint disease when cartilage destruction exceeds repair, causing pain and disability

Question 2

Explain the aetiology/risk factors of osteoarthritis

Answer 2

Can be classified according to the distribution of affected joints

Pathogenesis
Synovial joint cartilage destruction
Eventually, there is loss of joint volume due to altered chondrocyte activity
Patchy chronic synovial inflammation
Fibrotic thickening of joint capsules

Primary Osteoarthritis
UNKNOWN aetiology
Multifactorial causes

Secondary Osteoarthritis
Other diseases lead to altered joint architecture and stability
Commonly associated diseases include:
Developmental abnormalities (e.g. hip dysplasia)
Trauma (e.g. previous fractures)
Inflammatory (e.g. rheumatoid arthritis, gout, septic arthritis)
Metabolic (e.g. haemochromatosis, acromegaly)

Question 3

Summarise the epidemiology of osteoarthritis

Answer 3

COMMON
25% of those > 60 yrs
More common in FEMALES, CAUCASIANS and ASIANS

Question 4

Recognise the presenting symptoms of osteoarthritis

Answer 4

Joint pain and discomfort (Use-related)

Stiffness or gelling after inactivity

Difficulty with certain movements

Feelings of instability

Restriction walking, climbing stairs and doing manual tasks

Systemic features are usually absent

Question 5

Recognise the signs of osteoarthritis on physical examination

Answer 5

Local joint tenderness

Bony swellings along joint margins
Heberden’s Nodes-DISTAL interphalangeal joint
Bouchard’s Nodes-PROXIMAL interphalangeal joint

Crepitus and pain during joint movement

Joint effusion

Restriction of range of joint movement

Question 6

Identify appropriate investigations for osteoarthritis

Answer 6

Joint X-Ray of the affected joint will show FOUR classic
features:
Loss of joint space (narrowing)
Osteophytes
Subchondral cysts
Subchondral sclerosis