Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

disabling joint disease characterized by a noninflammatory degeneration of the joint complex (articular cartilage, subchondral bone, and synovium)

Question 2

What are some risk factors of osteoarthritis?

Answer 2

(Modifiable) Obesity
Excessive joint loading or overuse
(Non-modifiable) Age (> 55 years)
Familial history
History of joint injury or trauma
Anatomic factors causing asymmetrical joint stress

Question 3

What are the clinical features of osteoarthritis?

Answer 3

(Early) Pain on exertion, which is relieved with rest
Pain in both complete flexion and extension
Crepitus
Joint stiffness and restricted range of motion
Radiating or referred pain

(Late) Constant pain (including at night)
Morning joint stiffness usually lasting < 30 minutes

Question 4

What are Heberden’s and Bouchard nodes?

Answer 4

(Heberden’s nodes) Pain and nodular thickening on the dorsal sides of the distal interphalangeal joints (DIP)

(Bouchard’s nodes) Pain and nodular thickening on the dorsal sides of the proximal interphalangeal joints (PIP)

Question 5

How is osteoarthritis diagnosed?

Answer 5

(X-ray) Irregular joint space narrowing
Subchondral sclerosis (dense area of bone just below cartilage zone)
Osteophytes
Subchondral cysts (Fluid-filled cysts that develop at the surface of a joint due to local bone necrosis)

Question 6

What is the treatment for osteoarthritis?

Answer 6

(Lifestyle changes) weight loss, given advice about local muscle strengthening exercises and general aerobic fitness
(Pain medication) paracetamol and topical NSAIDs

oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids (seconds line)

(If conservative treatments fail) Joint replacement therapy