Osteoarthritis

Question 1

Define

Answer 1

Age-related degenerative synovial joint disease when cartilage destruction exceeds repair, causing pain and disability

ASSYMETRICAL

Question 2

Causes

Answer 2

Can be classified according to the distribution of affected joints

Pathogenesis

• Synovial joint cartilage destruction
• Eventually, there is loss of joint volume due to altered chondrocyte activity
• Patchy chronic synovial inflammation
• Fibrotic thickening of joint capsules

Primary Osteoarthritis

• UNKNOWN aetiology
• Multifactorial causes

Secondary Osteoarthritis

• Other diseases lead to altered joint architecture and stability

Commonly associated diseases include:

• Developmental abnormalities (e.g. hip dysplasia)
• Trauma (e.g. previous fractures)
• Inflammatory (e.g. rheumatoid arthritis, gout, septic arthritis)
• Metabolic (e.g. haemochromatosis, acromegaly)

Question 3

Epidemiology

Answer 3

COMMON

25% of those > 60 yrs

More common in FEMALES, CAUCASIANS and ASIANS

Question 4

Symptoms

Answer 4

• Joint pain or discomfort – use-related with stiffness/gelling after inactivity
• Difficulty with certain movements or feelings of instability
• Restriction walking/stairs/manual tasks
• Systemic features typically absent

Question 5

Sign

Answer 5

• Local joint tenderness
• Bony swellings along joint margins (Heberden’s and
• Bouchards nodes)

Heberden’s Nodes - DISTAL interphalangeal joint

Bouchard’s Nodes - PROXIMAL interphalangeal joint

• Crepitus and pain during joint movement
• Joint effusions
• Restriction of range of joint movement

Question 6

Investigations

Answer 6

Identify appropriate investigations for osteoarthritis

Joint X-Ray of the affected joint will show FOUR classic features:

1. Loss of joint space (narrowing)
2. Osteophytes
3. Subchondral cysts
4. Subchondral sclerosis