Osteoarthritis and Priciples of Management Flashcards

1
Q

Define osteoarthritis

A
  • “Tear, flare and repair”
  • Due to aging and wear and tear on a joint
  • Trauma + mechanical imbalance
  • Inflammation + pain
  • Repair processes around the joint
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2
Q

Biochemical risk factors for OA

A
  • Obesity
  • Persistent heavy physical activity or elite running
  • Abnormal anatomy (DDH)
  • Ligament rupture
  • Meniscal injury
  • Occupation (sportsmen, farmers)
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3
Q

Describe the inflammation seen in OA

A
  • Synovial hypertrophy
  • Subchondral changes
  • Joint effusion
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4
Q

Signs + symptoms of OA for localised disease

A
  • Usually hip or knee
  • Pain on movement + crepitus
  • Worse at end of day
  • Background pain at rest
  • Joint gelling (stiffness after 30mins rest)
  • Joint instability
  • May be joint tenderness, derangement + bony swelling
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5
Q

Red flags of suspected OA presentation

A
  • Trauma
  • Prolonged morning related stiffness
  • Rapid deterioration of symptoms
  • Hot swollen joint
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6
Q

DDx of OA

A
  • Gout
  • Other inflammatory arthritis
  • Septic arthritis
  • Malignancy
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7
Q

4 non-pharmacological Rx for OA

A
  • Thermotherapy
  • Electrotherapy
  • Manual therapy
  • Aids + devices
  • Exercise to improve local muscle strength
  • Weight loss if overweight
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8
Q

Pharmacological Rx of OA

A
  • Regular analgesia (paracetamol +/- topical NSAIDs/capsaicin)
  • If ineffective give codeine or short term oral NSAIDs (+PPI (omeprazole) )
  • IA steroids with severe symptoms
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9
Q

When to refer OA patient to surgery

A
  • Substantial impact on QOL

- Refractory to non-surgical treatment

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10
Q

What does the LOSS pneumonic refer to

A
  • Loss of joint space
  • Osteophytes
  • Subarticular sclerosis
  • Subchondral cyst

X-ray features of OA

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11
Q

Typical age of onset of OA

A

> 50yrs

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12
Q

Examples of 3 conditions OA is secondary to

A
  • Haemochromatosis
  • Obesity
  • Occupational
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13
Q

Investigations for OA

A
  • Plain radiograph (shows LOSS)
  • CRP may be slightly elevated
  • Aspiration of joint fluid (look for blood, pus +/or crystals) + send it for gram stain + polarised light microscopy
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14
Q

What are the bony swellings in OA, where are found commonly and what causes them

A
  • Herberden’s nodes
  • Usually DIP joints
  • They are a sign of OA
  • Caused by formation of osteophytes of the articular cartilage in response to repeated trauma at the joint
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15
Q

Swellings on the DIP + PIP

A
  • DIP = Herberden’s nodes (sign of OA)

- PIP = Bouchard’s nodes (sign of OA + RA)

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16
Q

Surgical treatment for OA

A

Joint replacement