Osteoarthritis

Question 1

What is osteoarthritis?

Which sort of joints does it occur in?

What is it caused by?

Answer 1

mechanical wear and tear of the joints, due to imabalnce between cartilage being worn down and chondrocytes repairing it - leading to structural issues

not an inflammatory condition like Rheumatoid arthritis

occurs in synovial joints

caused by a combo of genetic factors, overuse and injury

Question 2

What is the theory of underlying cause?

Answer 2

Imbalance between cartilage being worn down and chondrocytes repairing it leading to structural issues in the joints

Question 3

What the key changes seen in X-ray?

How do x-ray changes correlate with symptoms?

Answer 3

LOSS

• Loss of joint space
• Osteophytes forming at joint margins
• Subchrondral cysts (fluid filled holes in the bone)
• Subchondral sclerosis (increased density of the bone alone the joint line)

symptoms and x-ray findings do not always correlate, can have severe disease symptoms without severe xray finding and vice versa

Question 4

How does osteoarthritis present?

commonly affected joints?

Answer 4

• joint pain and stiffness
• worsened by exercise
• no morning stiffness
• unilateral symptoms
• no systemic upset

Large joints: hips, knees, sacroiliac
cervical spine and wrist
DIP
MCP joint at the base of the thumb

Question 5

What are the sign’s you would expect to see in the hands in osteoarthritis?

Answer 5

1. Haberden’s nodes - DIP joints
2. Bouchard’s nodes - PIP
3. squaring at the base of the thumb at the carpometacarel joint
4. weak grip
5. reduced range of motion

Question 6

How do you diagnose Osteoarthritis?

Answer 6

without investigation if:

• 45+
• typical activity related pan
• has no morning stiffness
• or stiffness lasting less than 30 mins

Question 7

How do you manage osteoarthritis?

Answer 7

1. patient education: weight loss, muscle strengthening exercise, general fitness
2. Physiotherapy, occupational therapy, orthotics

Pharma/Interventions

1. 1st line: Paracetamol and topical NSAIDs - tn: knee and hand
2. 2nd line: oral NSAIDs/COX-2 inhibitors, capsaicin cream
3. opioids (codeine, morphine)
4. interarticular steroid injections
5. Joint replacement

Question 8

What is the evidence of glucosamine + what is it?

Answer 8

glycosaminoglycans are natural costituents in cartilage and synovial fluid

some evidence it can be effective but recent research mixed. not given on the NHS