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
