Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

Progressive synovial joint damage resulting in structural changes, pain and reduced function
Loss of cartilage at synovial joints accompanied by degeneration of the underlying bone
Loss of the balance between cartilage degradation and cartilage repair

Question 2

What is primary OA?

Answer 2

Insidious, progressive impairment of joint function with not clear cause

Question 3

What is secondary OA?

Answer 3

Predisposing condition
Previous injury
Inappropriate mechanical stress

Question 4

What joints are affected in OA?

Answer 4

Hips, knees, SI joints, DIPs, MCP at the base of the thumb, wrist, cervical spine

Question 5

Features of joint pain in OA

Answer 5

Worse on activity, relieved by rest

Asymmetrical

Question 6

Features of joint stiffness in OA

Answer 6

Worse after long periods of inactivity

<30min in the morning

Question 7

Other features of OA

Answer 7

Joint swelling (hard)
Crepitus
Osteophytes

Question 8

Where are Herberden’s nodes in OA?

Answer 8

DIPs

Question 9

Where are Bouchard’s nodes in OA?

Answer 9

PIPs

Question 10

Which types of node is more common in OA?

Answer 10

Herberden’s

Question 11

XR features in OA

Answer 11

Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

Question 12

Non-pharmacological management of OA

Answer 12

Physiotherapy
Weight loss
Strength training

Question 13

Pharmacological management of OA

Answer 13

1. Oralparacetamoland topicalNSAIDsor topicalcapsaicin(chilli pepper extract).
2. Add oral NSAIDs (consider a PPI)
3. Consider opiates (codeine, morphine)
   Intra-articular steroid injection

Question 14

When is surgical management indicated in OA?

Answer 14

Joint replacement in patients whose quality of life is impacted and where non-surgical options are ineffective