Osteoarthritis

Question 1

RF for OA

Answer 1

Obesity

Age

Occupation

Trauma

Female

Family History

Question 2

Xray changes in OA

Answer 2

L – Loss of Joint Space

O – Osteophytes

S – Subarticular Sclerosis (increased density of the bone along the joint line)

S – Subchondral Cysts (fluid filled holes in the bone, aka geodes)

Question 3

COmmonly affected joints in OA (7)

Answer 3

Hips

Knees

Sacro-iliac joints

Distal-interphalangeal joints in the hands (DIPs)

The MCP joint at the base of the thumb

Wrist

Cervical spine

Question 4

Hand signs in OA

Answer 4

Haberdens nodes (in the DIP joints)

Bouchards nodes (in the PIP joints)

Squaring at the base of the thumb at the carpo-metacarpal joint

Weak grip

Reduced range of motion

Question 5

Diagnosis of OA

Answer 5

Can be made without any investigations if the patient is over 45

Typical activity related pain

No morning stiffness or stiffness lasting less than 30 minutes

Question 6

Management of OA

Answer 6

Patient education - weight loss to reduce load, physio to improve strength

Analgesia -

1. paracetamol and topical NSAIDs
2. add oral NSAIDS
3. codeine and morphine

Intra-articular steroid injections
Joint replacement in severe cases