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Y3 Medicine: Rheumatology > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is osteoarthritis?

A

Osteoarthritis (OA) is the result of mechanical and biological events that destabilise the normal process of degradation and synthesis of articular cartilage chondrocytes, extracellular matrix, and subchondral bone.

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2
Q

What part of joints are affected in OA?

A

It involves the entire joint, including the articular cartilage, subchondral bone, pericapsular muscles, capsule, and synovium.

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3
Q

What changes occur to the joints in OA?

A

The condition leads to:

  • Loss of cartilage
  • Sclerosis and eburnation of the subchondral bone
  • Osteophytes
  • Subchondral cysts
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4
Q

What are the risk factors for OA?

A
  • Age >50
  • Female
  • Obesity
  • Genetic factors
  • Knee malalignment
  • Physically demanding occupation or sport
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5
Q

What are the symptoms of OA?

A
  • Pain
  • Functional difficulties
  • Tenderness
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6
Q

What are the signs of OA?

A
  • Bony deformities
  • Limited range of motion
  • Malalignment
  • Crepitus
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7
Q

Which joints are commonly affected in OA?

A

Commonly involved joints are the knee, hip, hands, and lumbar and cervical spine.

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8
Q

How can hand OA be differentiated between rheumatoid arthritis?

A

Hand OA spares the metacarpophalangeal (MCP) joints and involves the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, which helps to distinguish it from rheumatoid arthritis.

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9
Q

What’s the difference between Bouchard’s and Heberden’s nodes?

A

Bouchard’s nodes= proximal interphalangeal (PIP) joints

Heberden’s nodes= distal interphalangeal (DIP)

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10
Q

Give examples of knee malalignment common in OA

A
  • Genu valgum (knock-knees)
  • Genu varum (bow-legs)
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11
Q

What investigations should be ordered for OA?

A
  • X-ray of affected joints
  • Serum CRP
  • Serum ESR
  • Rheumatoid factor
  • Anti-CCP antibody
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12
Q

Why investigate using x-ray? What may this show?

A
  • Plain radiographs should be performed in the initial work-up to help confirm the diagnosis in moderate to advanced OA, but they are not sensitive in detecting early disease.
  • New bone formation (osteophytes), joint space narrowing and subchondral sclerosis and cysts.
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13
Q

Why investigate serum CRP? And what may this show?

A
  • OA is a clinical diagnosis, but inflammatory markers should be ordered if inflammatory arthritis is a possible differential.
  • Normal.
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14
Q

Why investigate serum ESR? And what may this show?

A
  • OA is a clinical diagnosis, but inflammatory markers should be ordered if inflammatory arthritis is a possible differential.
  • Normal.
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15
Q

Why investigate rheumatoid factor? And what may this show?

A
  • Indicated if rheumatoid arthritis (RA) cannot be excluded clinically or if there is a suspicion that the patient might have both RA and OA.
  • Negative.
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16
Q

Why investigate anti-CCP antibody? And what may this show?

A
  • Indicated if rheumatoid arthritis (RA) cannot be excluded clinically or if there is a suspicion that the patient might have both RA and OA.
  • Negative.
17
Q

What is the main goal for OA treatment?

A

The main goal of treatment in OA is controlling joint pain and stiffness to improve function.

18
Q

Briefly describe the treatment of OA

A
  • Treatments include non-pharmacological (patient education, self-management, and exercise programmes) and pharmacological therapies, and surgery.
  • Different treatments should be combined, and therapy must be individualised.
19
Q

What non-pharmacological therapies are used to treat OA?

A
  • Patient education, self-management, and exercise programmes (with reassurance that exercise, e.g., resistance training, tai chi, yoga, and water-based exercise, is not harmful to the joints).
  • Physiotherapy and occupational therapy, as well as manual mobilisation, are also recommended.
20
Q

What pharmacological treatments are used in OA?

A
  • Topical and oral analgesia
  • Opioids
  • Duloxetine
  • Intra-articular corticosteroid injections
  • Intra-articular viscosupplementation
21
Q

What is the role of topical analgesia in OA?

Give examples of topical analgesia in OA

A
  • Topical analgesics should be used as first-line therapy for OA.
  • Capsaicin, methylsalicylate and non-steroidal anti-inflammatory drugs [NSAIDs].
22
Q

What is the role of oral analgesia in OA?

Give examples of oral analgesia in OA

A
  • Oral NSAIDs are more effective than paracetamol for the management of OA pain; however, they are associated with more serious GI and renal toxicity.
  • Selective COX-2 inhibitors are associated with reduced risk of GI adverse effects, but similar renal toxicity, compared with non-selective NSAIDs.
  • Naproxen, ibeuprofen, diclofenac sodium and diclofenac potassium.
23
Q

What is needed as an adjunct if long-term NSAIDs are indicated in OA?

A

Gastroprotection (e.g. PPIs) should be considered for patients on long-term NSAID therapy, especially those at risk of GI bleeding.

24
Q

What is the role of opioids in OA?

Give examples of opioids used in OA

A
  • Opioids may be used for pain relief in patients whose symptoms are inadequately controlled, or in whom the other agents are inadequate or contraindicated.
  • Oxycodone, codeine phosphate and tramadol.
25
Q

What is the role of duloxetine in OA?

A

May be effective for the treatment of chronic pain associated with OA.

26
Q

What is the role of intra-articular cortiosteroid injections and intra-articular viscosupplementation in OA?

A

Intra-articular corticosteroid injections and intra-articular viscosupplementation are useful, particularly in the knee, for acute exacerbations of OA or when NSAIDs are contraindicated or not tolerated. These interventions can be used in addition to the non-pharmacological therapies and analgesia.

27
Q

At what point may OA patients be referred for surgical joint replacement?

A

Patients with OA pain that persists despite multiple treatment modalities, or pain requiring regular opioids or causing severe disability, should be referred for an orthopaedic opinion and be considered for joint replacement surgery.

28
Q

What complications are associated with OA?

A
  • Functional decline and inability to perform activities of daily living
  • Spinal stenosis in cervical and lumbar OA
  • NSAID-related GI bleeding
  • Effusion
  • NSAID-related renal dysfunction
29
Q

What differentials should be considered in OA?

A
  • Bursitis
  • Gout
  • Pseudogout
  • Rheumatoid arthritis
30
Q

How does OA and bursitis differ?

A
  • Differentiating signs and symptoms: greater trochanteric bursitis in the hip and pes anserine bursitis in the knee present with pain over the lateral aspect of the hip and over the medial aspect of the knee, respectively. There is also local tenderness in these areas that is usually absent in simple OA.
  • Differentiating investigations: local anaesthetic and corticosteroid injection might be therapeutic and diagnostic if it relieves symptoms to a significant degree.
31
Q

How does OA and gout differ?

A
  • Differentiating signs and symptoms:
  • Differentiating investigations:
32
Q

How does OA and pseudogout differ?

A
33
Q

How does OA and rheumatoid arthritis differ?

A

Y3 Medicine: Rheumatology (5 decks)

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