Osteoarthritis and Principles of Management Flashcards
What is the commonest form of joint problem?
Osteoarthritis
Describe the pathogenesis of osteoarthritis?
- Trauma and mechanical imbalance
- Inflammation and pain
- Repair processes around joint
What are risk factors for biomechanical fractures?
- Abnormal anatomy
- Intra-articular fracture
- Ligament rupture
- Meniscal injury
- Occupation
- Farmers, football players
- Persistent heavy physical activity
- Obesity
What inflammation occurs in osteoarthritis?
- Synovial hypertrophy
- Subchondral changes
- Joint effusion
How is osteoarthritis diagnosed?
- Made on clinical grounds
- 45+ years in general
- Activity related joint pain plus
- Either no morning joint related stiffness or morning stiffness that lasts no longer than 30 minutes
Describe the typical presentation of osteoarthritis?
- Activity related joint pain plus
- No morning joint-related stiffness
- OR
- Morning stiffness that lasts no longer than 30 minutes
What are some clinical features not common in osteoarthritis and suggestive of other inflammatory process?
- Prolonged morning stiffness
- Rapid deterioration of symptoms
- Hot, swollen joint
What is the differential diagnosis of osteoarthritis?
- Gout
- Other inflammatory arthritides
- Septic arthritis
- Malignancy
What investigation should be done for osteoarthritis to confirm diagnosis?
- X-ray to confirm clinical diagnosis
- No x-ray changes in early stages, only on MRI
Where are most patients with osteoarthritis managed?
Most patients managed in community by MDT
What is the treatment for osteoarthritis?
- Self management in early stages
- Weight loss and exercise
- Occupation
- Effect on social life
- Pain assessment
- Additional treatment options are non-pharmacology, pharmacological and surgical
- Non-pharmacological
- Thermotherapy
- Electrotherapy
- Aids and devices
- Manual therapy
- Pharmacological
- Oral analgesia
- Paracetomol, NSAIDs
- Topical treatment
- NSAIDs, capsaicin
- Intra-articular injections
- Steroids (hyaluronic acid)
- Oral analgesia
- Surgery
- Refer when
- Substantial impact on QoL
- Refractory to non-surgical treatment
- Referral letter
- Joint replacement surgery is treatment for advanced osteoarthritis (OA)
- Refer when
What are some non-pharmacological therpies for osteoarthritis?
- Thermotherapy
- Electrotherapy
- Aids and devices
- Manual therapy
NOT ACUPUNCTURE
What are some pharmacological therpies for osteoarthritis?
- Oral analgesia
- Paracetomol, NSAIDs
- Topical treatment
- NSAIDs, capsaicin
- Intra-articular injections
- Steroids (hyaluronic acid)
When should patients with osteoarthritis be referred for surgery?
- Refer when
- Substantial impact on QoL
- Refractory to non-surgical treatment
What is the surgical treatment for osteoarthritis?
- Joint replacement surgery is treatment for advanced osteoarthritis (OA)
