Osteoarthritis Flashcards
Summarise what OA is.
· A degenerative joint disorder.
· Result of mechanical and biological events that:
- Destabilise the normal process of degradation.
- Destabilise the synthesis of articular cartilage chondrocytes.
· Involves the entire joint.
· Condition leads to loss of cartilage.
Who is most affected?
· More common in women.
· Prevalence increases with age.
What is the pathophysiology of OA?
· Failure in maintaining the homeostatic balance of the cartilage matrix synthesis and degradation.
· This results in reduced bone formation and increased catabolism.
What is the aetiology of OA?
· No single cause.
· Host of biological and mechanical factors that culminate in the development of OA.
What are the risk factors for OA?
· Age >50. · Hereditary predisposition. · Female. · Obesity - Knee OA. · Physical/manual occupation. · Joint trauma. · High bone mineral density. · Low oestrogen status, such as in post-menopausal women. · Conditions such as haemochromotosis and EDS.
List the most common signs and symptoms.
· Most commonly affected joints are the knee, hip, hands, lumbar and cervical spine.
· Joint pain and stiffness that’s worse with activity.
· Pain.
· Swelling.
· Crepitus.
· Heberden’s nodes at DIP joints - ‘outer Hebrides’.
· Bouchard’s nodes at PIP joints.
· Functional difficulties - knee giving way/locking.
· Bony deformities.
· Limited range of motion.
Malalignment - particularly in the knee where OA causes both gene valgum (knock-knees) and genu varum (bow-legs).
What investigations would you request if you suspected a patient had OA?
· X-ray.
· CRP.
· ESR.
· Rheumatoid factor and anti-CCP antibody - negative.
What would the investigation results show?
· X-ray - LOSS:
- L - Loss of joint space.
- O - Osteophytes.
- S - Subchondral cysts.
- S - Sclerosis.
· CRP - normal.
· ESR - normal.
· Rheumatoid factor and anti-CCP antibody - negative.
Suggest some differential diagnoses.
· Bursitis. · Gout. · Pseudogout. · RA/Psoriatic arthritis. · Avascular necrosis. · Internal derangements such as meniscal tears.
What are the non-pharmacological treatment options?
· Physiotherapy.
· OT.
· Strengthening exercises.
What are the pharmacological treatment options?
· Paracetamol, topical diclofenac, NSAIDS, opioids.
· Intra-articular corticosteroid injections.
· Gastro-protection.
What other treatment options are available?
Surgery (TJR or TKR) - if patient’s don’t respond to medical or non-medical therapies.
What complications may arise?
· Functional decline and inability to perform activities of daily living.
· Spinal stenosis in cervical or lumbar OA.
· NSAID-related GI bleeding.
· Gout.