Osteoarthritis Flashcards
What is osteoarthritis?
“Wear and tear of joints” that occurs in synovial joints. Not an inflammatory condition like RA. Clinically characterised by joint pain, stiffness and functional limitation
Discuss the pathophysiology of OA
Imbalance between the cartilage being worn down and the chondrocytes repairing it leading to loss of articular cartilage accompanied by new bone formation and capsular fibrosis
State 3 possible scenarios/aetiologies for OA
- Failure of normal cartilage subject to abnormal load for long periods
- Damaged or defective cartialge failing under normal conditions
- Break up of cartilag due to stiffened subchondral bone passing more load to it
State two key features of cartilage in OA
- Loss of elasticity
- Cellularity and proteoglycan content reduced
State some risk factors for OA
- Age
- Obesity
- Trauma
- Joint malalignment
- Muscle weakness
- Family history (genetic studies show strong heritability for knee and hand OA but mehcansim not understand)
- Females (more commonly affected)
State some symptoms of OA
- Joint pain (worsended by activity)
- Joint stiffness (worsened by activity)
- Instability of joint
- Reduced function of joint
- Deformity of joint
- Joint tenderness
State what you might find on clinical examination of someone with OA
- Heberden’s nodes
- Bouchard’s nodes
- Squaring of base of thumb at carpo-metacarpal joint
- Weak grip
- Reduced range of motion
Describe:
- Heberden’s node
- Bouchard’s nodes
- Heberdens’s nodes: bony enlargement/swelling of DIPJ
- Bouchard’s nodes: bony enlargement/swelling of PIPJ
What is meant by squaring of the thumb?
Base of thumb becomes more prominent
What joints are commonly affected by OA?
Typically affects weight bearing joints.
- Hips
- Knees
- Sacro-iliac joints
- DIPS
- MCPJ of 1st metacarpal (thumb)
- Wrist
- Cervical spine
Discuss how diangosis of OA is made
NICE suggests that a diagnosis can be made without any investigations if pt is:
- >45 yrs
- Typical acitvity related pain
- No morning stiffness or stiffness lasting <30mins
What investigations would you do if you suspect OA?
But remember, NICE guidance says you can diagnose without any investigations if pt fits certain criteria
*Where approrpriate, justify why
- X-rays are really the only investigation you might do (but don’t often even need to do these as it is a clinical diagnosis)
- You may do CRP, ESR or rheumatoid tests if unsure if it is inflammatory arthritis
What are the 4 cardinal signs of OA on x-ray?
***Think LOSS
- Loss of joint space
- Osteophytes
- Subarticular slcerosis (increased density of bone along joint line)
- Subchondral bony cysts
*NOTE: x-ray changes don’t always correlate wtih symptoms
Discuss the management of OA, include:
- Non-pharmacological management
- Pharmacological management
- Surgical management
Non-pharmacological
- Educate pt about condition
- Lifestyle changes .e.g weight loss, activity modification
- Orthotics, walking aids (to reduce loading of joint)
- Physiotherapy to improve strength & support joint
- Occupational therapy to help with ADLs
Pharmacological
- Analgesia (stepwise):
- Oral paracetamol and topical NSAIDS or topical capsaicin
- Add oral NSAIDS and consider PPI
- Consider opiates e.g. codeine & morphine
- Intra-articular steroid injections (temporary reduction in inflammation & improve symptoms)
Surgical
- Joint replacement (hip or knee)
What is the issue with giving pts opiates for pain from OA?
- Significant side effects
- Pts can develop dependence and withdrawal
- Don’t work for chronic pain and result in pts becoming dependent on them without benefitting from pain relief
