Osteoarthritis Flashcards
What is OA?
‘Wear and tear’ of a joint. It is not inflammatory, and occurs in synovial joints
What three factors affect OA?
- Genetic factors
- Overuse
- Injury
What other risk factors are there for OA?
- Age
- Occupation
- Female sex
- Family history
What are the four XR changes in OA?
LOSS
- Loss of joint space
- Osteophytes
- Subchondral cysts
- Subarticular sclerosis
How do subchondral cysts appear on XR?
Fluid filled holes in the bone
How does subarticular sclerosis appear on XR?
Increased density along the joint line of a bone
How does OA present?
- Joint pain, worse after use e.g. in the evening
- Joint stiffness
- Crepitus
- Deformity/instability of the joint
Which large joints are commonly affected?
- Hips
- Knees
- Sacroiliac joints
- Cervical spine
Which small joints are commonly affected?
- DIPs of the fingers
- MCP of the thumb base
- Wrist joints
What signs might you see in the hands?
- Haberden’s Nodes
- Bouchard’s Nodes
- Squaring at the base of the thumb (carpo-metacarpal joint)
- Weak grip
- Reduced ROM
Why is the carpo-metacarpal joint prone to OA?
It’s a saddle joint, with the metacarpal bone sat on the trapezius bone like a saddle, and gets a lot of use in daily life.
How is OA diagnosed?
Clinically IF:
- Pt is over 45
- Has typical overuse pain
- Has no morning stiffness or it lasts less than 30 minutes
How is OA conservatively treated?
- Patient education
- Weight loss
- Physiotherapy
How is the pain managed in OA?
Stepwise:
1- PO paracetamol and topical NSAIDs, or topical capsaicin (chill extract)
2- PO NSAIDs and a PPI- better used intermittently rather than continuously
3- Opiates such as codeine or morphine, used cautiously due to dependence and withdrawal risks
What treatment is used to temporarily reduce inflammation and improve symptoms?
Steroid injections e.g. hydrocortisone
What surgery is used in OA?
Joint surface replacement/prostheses
