Osteoarthritis Flashcards
What is OA?
Joint disease resulting in breakdown of articular cartilage & underlying bone - due to mechanical ‘wear & tear’ of the joint
How common is OA?
Very common in the elderly
>50% of >60s have osteoarthritis
What are risk factors for OA?
Old age
Obesity
Persistently heavy activities - eg running
Physically demanding occupations - eg farmers
Certain conditions - esp DDH
Certain injuries:
- intra-articular fractures
- meniscal injuries
- ligament ruptures
What are the 2 types of osteoarthritis?
Primary - relating to peristent microtrauma (eg high load due to obesity)
Secondary - occuring after single acute trauma (eg fractures) or related to another condition (eg DDH)
Describe the pathogenesis of OA
Development of osteoarthritis revolves around trauma & mechanical imbalances damaging the articular surface of a joint - and an inadequate repair process for that joint
Inadequate repair process leads to structural issues - which leads to more damage occurring with usage
There is also inflammation (but OA is not an inflammatory disorder)
Although osteoarthritis is not an inflammatory arthritis - inflammation is still a feature
What inflammatory features are seen in OA?
Synovial hypertrophy
Subchondral changes
Joint effusion
What joints are typically affected by OA?
Unilateral or bilateral?
Knee
Hip
DIP & PIP
Carpometacarpal joint (of thumb)
Cervical spine (aka cervical spondylosis)
Typically unilateral (but can be bilateral - esp late disease & in hips)
Describe the typical presentation of OA
What key feature must you check to differentiate between OA & RA?
>45 yo - with fairly gradual onset of:
- pain - worse on activity, relieved by rest
- stiffness
- reduced function
No morning stiffness! or morning stiffness of <30 mins - morning stiffness is a key feature of RA
How would a patient with OA of the a) hip and b) knee typically describe their pain?
a) hip - groin pain +/- radiation down to knee
b) knee - pain in anterior knee
What are the differentials for OA?
Gout
Rheumatoid arthritis (+other inflammatory arthritides)
Septic arthritis
Malignancy
RA is a key differential for OA
What are their main differences in terms of symptoms?
Pain & stiffness:
- OA - worsened by activity, relieved by rest
- RA - worst in morning, improves with activity
Joints typically affected:
- OA - typically unilateral, of the large joints*
- RA - always bilateral, small joints of hands & feet
Systemic symptoms/features:
- OA - rarely any systemic upset
- RA - systemic upset/features are common
*OA commonly affects the small joints of hands too
How is OA investigated & diagnosed?
Give the criteria for diagnosis…
Can be diagnosed clinically (ie without investigation) if:
- >45 yo
- typical activity related joint pain
- absence of morning stiffness or morning stiffness lasting less than 30 mins
But if uncertainty:
- Xray
- CRP / ESR
What xray findings indicate OA?
Mnemonic - LOSS
Loss of joint space
Osteophytes - spurs of bone
Subarticular sclerosis
Subchondral cysts
Give an overview of the management of OA…
First steps following diagnosis:
- Self management & holistic care
- Exercise & weight loss
If above fails:
- Non-pharmacological treatment
- Pharmacological (analgesia & topicals)
- Surgery
*see NICE guidelines below
Self management is the first management option for OA
What does it involve?
Thermotherapy i.e. heat/ice
Rest or changed activities
OTC painkillers
Describe the importance of holistic care
Most cases are dealt without meds/surgery
Need to address the patient’s:
- Depression
- Ability to work
- Family roles
- Social isolation
- Daily living/hobbies
What non-pharmacological treatments are available for OA?
Thermotherapy
Electrotherapy (TENS)
Aids/devices e.g. walking stick
Manual Therapy e.g. Physio
What pharamacological therapies can we offer for OA?
Oral Analgesia e.g. paracetamol or NSAIDs
Topical e.g. NSAIDS or Capsaicin cream
When would surgery be considered for OA?
What surgical options are available for OA?
If substantial impact on QoL
If refractory to other treatments
Joint replacements
