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
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)
3
Q
Describe the inflammation seen in OA
A
- Synovial hypertrophy
- Subchondral changes
- Joint effusion
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
5
Q
Red flags of suspected OA presentation
A
- Trauma
- Prolonged morning related stiffness
- Rapid deterioration of symptoms
- Hot swollen joint
6
Q
DDx of OA
A
- Gout
- Other inflammatory arthritis
- Septic arthritis
- Malignancy
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
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
9
Q
When to refer OA patient to surgery
A
- Substantial impact on QOL
- Refractory to non-surgical treatment
10
Q
What does the LOSS pneumonic refer to
A
- Loss of joint space
- Osteophytes
- Subarticular sclerosis
- Subchondral cyst
X-ray features of OA
11
Q
Typical age of onset of OA
A
> 50yrs
12
Q
Examples of 3 conditions OA is secondary to
A
- Haemochromatosis
- Obesity
- Occupational
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
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
15
Q
Swellings on the DIP + PIP
A
- DIP = Herberden’s nodes (sign of OA)
- PIP = Bouchard’s nodes (sign of OA + RA)