Osteoarthritis

Question 1

Definition of osteoarthritis

Answer 1

• ‘Wear and tear’ in the joints
• Non-inflammatory condition

Question 2

Risk factors for OA

Answer 2

• Obesity
• Increasing age
• Occupation (manual workers)
• Trauma
• Female sex
• FHx

Question 3

X-ray changes in OA (remember LOSS)

Answer 3

• Loss of joint space
• Osteophytes
• Subarticular sclerosis (increased density of bone along joint line)
• Subchondral cysts (fluid filled holes in the bone)

NB - X-ray changes do not necessarily correlate with symptoms

Question 4

Presentation of OA

Answer 4

• Joint pain (worsened by activity)
• Stiffness (worsened by activity)

Question 5

Commonly affected joints in OA

Answer 5

• Hips
• Knees
• SAcro0iliac joints
• DIPs
• MCP at the base of the thumb
• Wrist
• Cervical spine

Question 6

Diagnosis of OA

Answer 6

• Diagnosis can be made clinically if patient is over 45 and has typical activity related pain with no morning stiffness or stiffness lasting less than 30 minutes

Question 7

Management of OA

Answer 7

• Patient education (weight loss)
• Physiotherapy (improve strength and support joint)
• Stepwise analgesia
  
  • Paracetamol and topical NSAIDs or topical capsaicin
  • Oral NSAIDs with PPI cover
  • Opiates such as codiene and morphine
• Intra-articular steroid injection for temporary reduction in inflammation
• Joint replacement in severe cases