Osteoarthritis

Question 1

Osteoarthritis Pathogenesis

Answer 1

-Localised loss of cartilage, remodelling of adjacent bone, associated inflammation

Question 2

Osteoarthritis Epidemiology

Answer 2

• One of the most common chronic diseases
• Age related
• Manifestations occur after middle age

Question 3

Osteoarthritis RFs

Answer 3

• Genetic factors
• Age, female sex, obesity, high or low bone density
• Biomechanical factors

Question 4

Osteoarthritis Diagnosis Criteria

Answer 4

• Diagnosis can be made clinically if
• Aged over 45 and
• Activity related joint pain and
• Either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes

Question 5

Osteoarthritis Presentation

Answer 5

• Joint pain that is exacerbated by exercise and relieved by rest
• Knee pain usually bilateral
• Hip pain usually felt in groin and anterior thigh, can be referred to knee and testicle
• Morning stiffness (<30 minutes)
• Reduced range of movement
• Pain on movement
• Joint swelling
• Periarticular tenderness
• Crepitus
• Absence of systemic features
• Bony swelling and deformity due to osteophytes (Bouchard’s and Heberden’s)

Question 6

Osteoarthritis Investigations

Answer 6

• Diagnosis usually based on clinical examination
• When disease is advanced it can be seen on plain X-rays (osteophytes, joint space narrowing, bone cysts, subarticular sclerosis)
• CRP, ESR

Question 7

Osteoarthritis Differentials

Answer 7

-Bursitis, pseudogout, psoriatic arthritis, septic arthritis, rheumatoid arthritis

Question 8

Osteoarthritis Management

Answer 8

• Topical analgesia (NSAIDs)
• Oral analgesia
• Steroid injections
• Opioid
• Lifestyle modification
• Surgery if persistent pain despite treatments or severe disability