Osteoarthritis

Question 1

Definition of osteoarthritis

Answer 1

1) Osteoarthritis (OA) is the result of mechanical and biological events that destabilise the normal process of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix, and subchondral bone.
2) It involves the entire joint, including the articular cartilage, subchondral bone, pericapsular muscles, capsule, and synovium.
3) The condition leads to loss of cartilage, sclerosis and eburnation of the subchondral bone, osteophytes, and subchondral cysts.
4) It is clinically characterised by joint pain, stiffness, and functional limitation.

Question 2

Hx of osteoarthritis

Answer 2

1) OA-related pain is usually associated with activities, with pain in weight-bearing joints being associated with weight-bearing activities. Pain at rest or at night is unusual, except in advanced OA.
2) Functional difficulties, such as a knee giving way or locking, can be present. This can reflect an internal derangement, such as a partial meniscal tear or a loose body within the joint.
3) Commonly involved joints are the knee, hip, hands, and lumbar and cervical spine.
4) Both active and passive range of joint movement is reduced in moderate to advanced OA, and this is usually associated with pain.
5) OA can cause local tenderness over the joint line.

Question 3

Risk factors of osteoarthritis

Answer 3

1) Age >50 years.
2) Female sex
3) Obesity
4) Genetic factors
5) Knee malalignment
6) Physically demanding occupation/sport

Question 4

Investigations of osteoarthritis

Answer 4

1) X-ray of affected joints: New bone formation (osteophytes), joint space narrowing, and subchondral sclerosis and cysts.
2) Serum CRP and ESR: Needed if inflammatory arthritis is a possible differential. Usually normal range.

Question 5

Management of osteoarthritis

Answer 5

1) Holistic approach and self-management:
• Assess the effect of OA on patient’s lifestyle.
• Agree a plan with the person.
• Take into account comorbidities that compound the effect of OA.
• Activity and exercise.
• Interventions to achieve weight loss if the patient is overweight.
2) Analgesics
• Paracetamol.
• Topical NSAIDs ahead of oral NSAIDs.
• Intra-articular injections.
3) Minimally invasive and non-invasive therapies
• Thermotherapy
• TENS
• Walking sticks
• Bracing/joint supports
4) Surgery – joint replacement (patient must be offered all non-surgical options)
• Patient who are refractory to medical management.
• Substantial impact on quality of life.

Question 6

Complications of osteoarthritis

Answer 6

1) Functional decline and inability to perform activities of daily living.
2) Spinal stenosis in cervical and lumbar OA
3) NSAID-related GI bleeding
4) Effusion of the joint
5) NSAID-related renal dysfunction