Osteoarthritis Flashcards
What is osteoarthritis?
Type of joint disease that results in the breakdown of joint cartilage and underlying bone.
Tear, flare (inflammatory response) and repair (doesn’t repair back to normality).
What are some biomechanical factors that cause OA?
Abnormal anatomy (DDH) Intra-articular fracture Ligament rupture Meniscal injury Occupation - farmers, footballers. Obesity Elite running Persistent heavy physical activity.
What are the differences between primary and secondary OA?
Primary - tends to be genetic or age related.
Secondary - tends to occur due to a pre-existing problem e.g mechanical imbalance. Type 1 collagen forms instead of type 2 during healing which causes weakness.
What are the features of inflammation in OA?
Synovial hypertrophy
Subchondral changes - weakness underneath chondral surface.
Joint effusion
What biochemical mediators are associated with inflammation in OA?
Increased levels of interleukin 1 beta.
TNF-alpha and MMPs are thought to be involved.
What is the pathogenesis of OA?
1 -Muscle weakness, ligament injury, abnormal anatomy.
2- Instability, malalignment, obesity.
3- Increased load
4- joint microtrauma
5- Osteoarthritic joint maybe with synovitis.
How is OA diagnosed?
45years +
Activity related joint pain + has either no morning joint related stiffness or morning stiffness that last no longer than 30 mins. (synovial fluid has had time to get back into joint surface).
What do you need to pay attention for in OA patients?
Trauma
Prolonged morning-related stiffness
Rapid deterioration of symptoms
Hot, swollen joint.
What is a differential diagnosis for OA?
Gout
Other inflammatory arthritides
Septic arthritis
Malignancy
What investigations would you like to do for suspected OA patient?
X-ray to confirm.
2 at 90 degrees to each other. Try and get weight bearing x-rays where possible.
What is the initial treatment of OA in primary care?
Holistic approach and self management.
Information, exercise and weight loss.
Non-pharmalogical - thermotherapy (heat packs), electrotherapy, walking aids and devices, manual therapy.
What are some pharmacological treatments for OA?
Oral analgesia - paracetamol, NSAIDs.
Topical treatments - NSAIDs, capsaicin (knees and hands).
Intra-articular injections - steroid, hyaluronic acid.
When should someone with OA be referred to surgery?
Substantial impact on quality of life.
Refractory to non-surgical treatment.
Referral letter
Typically had symptoms a year or more.
What are the key features of OA on x-ray?
Osteophytes Loss of joint space Bone on bone Sunchondral cysts Subchondral sclerosis Flattened head of bones
