osteoarthritis and management

Question 1

osteoarthritis definition

Answer 1

tear, flare and repair

tear - microdamage to joint cartilage

flare - inflammatory response

repair- attempted continually until damage overcomes repair mechanism

Question 2

pathogenesis of OA

Answer 2

possible repetitive micro-trauma, maybe mechanical imbalance

secondary inflammation and pain

ongoing repair processes around joint

Question 3

what abnormalities can predispose to OA

Answer 3

abnormal anatomy e.g. DDH
intra-articular gracture 
ligament fracture 
meniscal fracture 
occupation - farmer, footballer
elite running 
obesity

Question 4

characteristics of OA

Answer 4

activity-related joint pain
no morning joint stiffness or if there is lasts <30mins

45+ usually

Question 5

investigations for OA

Answer 5

x-ray to confirm clinical diagnosis

*no changes in early disease

Question 6

non-pharmacological therapies for OA

Answer 6

thermotherpay - heat
electrotherapy
aids and devices - splints, walking sticks
manual therapy - massage, manipulation, physiotherapy

NICE dont recommend acupunturte

Question 7

pharmacological Rx OA

Answer 7

oral analgesia - paracetamol, NSAIDs

topical - NSAIDs, capsaicin

IA injections - steroids, hyaluronic acid

Question 8

when to refer OA to surgery

Answer 8

substantial impact QOL

no response to any of non-surigical Rx

Question 9

x-ray changes

Answer 9

subchondral cysts
joint space narrowing
osteophytes