Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

‘Wear and tear’ in the joints, NOT inflammatory.

Question 2

What is the pathophysiology of osteoarthritis?

Answer 2

Imbalance between cartilage being worn down and the chondrocytes repairing it leading to structural issues.

Question 3

What is this joint x-ray finding suggestive of?

1. Loss of joint space
2. Osteophytes
3. Subchondral sclerosis
4. Subchondral cysts

Answer 3

Osteoarthritis (or pseudogout if chondrocalcinosis is present)

Question 4

What is this a presentation of?

Obese women over 45, joint pain and stiffness worsened by activity, some hand signs.

Answer 4

Osteoarthritis

Question 5

What can osteoarthritis lead to in the joint?

Answer 5

Deformity, instability, and reduced function.

Question 6

Which joints are commonly affected in osteoarthritis?

Answer 6

1. Hips and knees
2. Sacro-iliac joint
3. DIP, PIP, MCP
4. Wrist
5. Cervical spine

Question 7

Which signs can be found in the hands in osteoarthritis?

Answer 7

1. Heberden’s nodes - DIP
2. Bouchard’s nodes - PIP
3. Squaring at the carpometacarpal joint
4. Weak grip
5. Reduced range of motion

Question 8

How is a diagnosis of osteoarthritis made?

Answer 8

Can be made with no investigations if:

1. Patient is over 45
2. Typical activity-related pain
3. Stiffness does not occur in the morning or last less than 30 mins

Question 9

What is the non-pharmaceutical management of osteoarthritis?

Answer 9

Patient education, weight loss advice, physiotherapy, occupational therapy, orthotics.

Question 10

What is the step-wise analgesia for osteoarthritis?

Answer 10

1. Oral paracetamol and topical NSAIDs/capsaicin
2. Add oral NSAIDs (Prescribe PPI)
3. Consider opiates - codeine/morphine

Question 11

What is the pharmaceutical and surgical treatment for osteoarthritis?

Answer 11

1. Intra-articular steroid injections - symptom relief

2. Joint replacement in severe cases (hip/knee commonly)