Osteoarthritis

Question 1

What is Osteoarthritis?

Answer 1

Most common form of arthritis and a disease of the synovial joints

Question 2

What are the risk factors of Osteoarthritis?

Answer 2

• Age (>50 years)
• Obesity
• Occupation
• Genetic factors

Question 3

What are the causes of Osteoarthiritis?

Answer 3

• Localised loss of cartilage
• Remodelling of adjacent bone
• Associated inflammation

Question 4

What are the possible causes of cartilage destruction?

Answer 4

• Metalloproteases - (breakdown protein and collagen secreted by chondrocytes)
• IL-1 and TNF-a - (cause metalloproteases to inhibit collagen production)
• Deficiency of growth factors
• Genetic susceptibility

Question 5

What are the clinical features of Osteoarthritis?

Answer 5

• Pain and Crepitus on movement
• Herbedens nodes at DIPS and Bouchards nodes at PIPS
• Tenderness
• Reduced range of motion

Question 6

What are the main jointed affected in Osteoarthritis?

Answer 6

• Large weight bearing joints
• Carpometacarpal joints
• DIPS and PIPS

Question 7

What is the differential diagnosis of Osteoarthritis?

Answer 7

• Rheumatoid Arthritis
• Bursitis
• Gout
• Psoriatic Arthritis

Question 8

What are the main differences between Osteoarthritis (OA) and Rheumatoid Arthritis (RA)?

Answer 8

• RA is autoimmune where as OA is more as a result of mechanical wear ad tear
• RA is more common in females where as OA has similar incidences in males and females
• RA is seen in adults of all ages where as OA is more common in elderly
• RA affects MCPs and PIPS where as OA affects others
• RA sees morning stiffness where as OA sees pain following use
• RA is symmetrical in nature where as OA is uni-lateral

Question 9

What are the investigations in suspected Osteoarthirits?

Answer 9

=> Bloods - CRP, ESR, RF

• CRP elevated
• ESR elevated
• RF absent

=> MRI

=> X Ray - 1st line - use mneumonic LOSS

L - Loss of joint space
O - Osteophytes
S - Subarticular sclerosis
S - Subachondral cysts

Question 10

What is the management of Osteoarthiritis?

Answer 10

=> Conservative management:

• Lose weight
• Local strengthening an aerobic exercises
• Joint supports

=> Medical management:

• Regular Paracetamol + Topical NSAIDs
• If this does not work, move up pain ladder to PO NSAIDs and intra-articular steroid injections. PPIs co-prescribed
• Avoid topical NSAIDs for osteoarthritis of hips

=> Surgical management:
- Total hip or knee replacement for hip osteoarthritis

Question 11

What are the complications of total hip replacement?

Answer 11

• Venous thromboembolism
• Intraoperative fracture
• Nerve injury

Question 12

What are the reasons for revision of total hip replacement?

Answer 12

• Aseptic loosening (most common reason)
• Pain
• Dislocation
• Infection