Osteoarthritis

Question 1

what kind of disease is osteoarthritis

Answer 1

a degenerative joint disease, the most common type of joint disease

Question 2

describe the primary causes of osteoarthritis

Answer 2

insidious, no overt cause, age related

Question 3

describe the secondary/predisposing causes of osteoarthritis

Answer 3

excess/inappropriate weight bearing(obesity), female, injury, systemic conditions, genetic factors

Question 4

what joints does osteoarthritis usually affect

Answer 4

hips, knees, lower lumbar and cervical vertebrae, PIP and DIP joints in fingers
(wrists, shoulder and elbows usually spared)

Question 5

what is felt at the joints in osteoarthritis

Answer 5

aches and pains that are worse with use

Question 6

describe the initial pathology in osteoarthritis

Answer 6

degeneration of the cartilage and disordered repair

Question 7

what pathological changes are seen in early osteoarthritis

Answer 7

damage to cartilage, clusters of chondrocytes, small fissures in cartilage, fibrillation

Question 8

describe the secondary pathology of ostearthrits

Answer 8

stimulation of inflammatory changes in synovium and subchondral bone, repetitive injury and chronic inflammation

Question 9

what pathological changes are seen in later stages of osteoarthritis

Answer 9

subchondral cysts, surface becomes polished(‘eburnation’), remodelling, formation of osteophytes

Question 10

describe what happens to the cartilage in the later stages of osteoarthritis

Answer 10

cartilage is completely worn away, bone to bone

Question 11

describe what an osteophyte is

Answer 11

a bone growth/projection formed at the margins of joints caused by stress and damage to surface

Question 12

describe what eburnation is

Answer 12

degenerative process at joint where friction causes reactive conversion of sub-chondral bone to an ivory-like surface at site of erosion

Question 13

describe the prevention of osteoarthritis

Answer 13

no specific means to prevent it, and once started little to prevent disease progression

Question 14

what different types of osteoarthritis are there(OA)

Answer 14

localised or generalised

Question 15

define generalised OA

Answer 15

OA at either spinal or hand joints and at least 2 other sites

Question 16

describe what Heberden’s and Bouchard’s nodes are

Answer 16

Heberden's = osteophytes at DIP joints of fingers
Bouchard's = osteophytes at PIP joints of fingers

Question 17

how does OA in the CMC joint of the hand present

Answer 17

as squaring of the thumb, thumb closer to hand than it should be

Question 18

describe the clinical presentations of OA

Answer 18

morning stiffness(<30mins), pain worse with joint use, instability, poor grip with thumb

Question 19

what is seen on examination of OA

Answer 19

joint line tenderness, crepitus, bony swelling, deformity, limitation of movement(esp. hip)

Question 20

what clinical features are seen in OA of the knee

Answer 20

effusions, crepitus, genu varus, valgus deformities, Baker’s cysts

Question 21

where may pain from hip OA be felt

Answer 21

in groin, or radiate to knee or be felt in lower back

Question 22

what may be seen in OA of the cervical spine

Answer 22

pain, restriction of movement, occipital headaches

Question 23

what may be seen in OA of lumbar spine

Answer 23

osteophytes can cause spinal stenosis

Question 24

what investigations can be used for OA

Answer 24

plain X-ray, MRI, ultrasound scan

Question 25

how is OA mainly diagnosed

Answer 25

usually a clinical diagnosis as imaging may not correlate with symptoms

Question 26

what may be seen on X-ray in OA

Answer 26

marginal osteophytes, joint space narrowing, subchondral sclerosis, subchondral cysts

Question 27

what is involved in the non-pharmacological treatment of OA

Answer 27

patient education, lifestyle management, physiotherapy, occupational therpay

Question 28

what is involved in the pharmacological treatment

Answer 28

NSAIDs, analgesia and local intra-articular steroid injections

Question 29

what surgical treatments can be used in OA

Answer 29

joint replacement or arthroscopic surgery to remove loose bodies etc.