Osteoarthritis and Principles of Management

Question 1

What is osteoarthritis?

Answer 1

Destruction of a joint

->articular cartilage is damaged and this cannot be regenerated
->most common joint problem

Question 2

Which joint is most affected by osteoarthiritis?

Answer 2

Joint as base of thumb

Question 3

Ooooh- why do dieticians have a role in osteoarthritis?

Answer 3

More weight a patient carries, more strain and stress of joints and makes symptoms worse

Question 4

What happens in osteoarthritis?

Answer 4

Trauma and mechanical imbalances causing inflammation and pain
There are then repair processes around the joint

Question 5

What are some of the biomechanical factors which can cause osteoarthritis?

Answer 5

Abnormal anatomy
Intra-articular fracture
Ligament rupture
Meniscal injury
Occupation e.g. farmers, football players
Obesity
Persisting heavy physical activity

Question 6

One of the abnormal anatomy conditions which can predispose to osteoarthritis is DDH. What happens?

Answer 6

Hip does not properly form in infant, if not identified and treated, joint grates away and gets damaged

Question 7

What happens in inflammation of joints in osteoarthritis?

Answer 7

Synovial hypertrophy
Subchondral changes- looser subchondral bone
Joint effusion

->synovial tissue produces synovial fluid so if synovial hypertrophy, more fluid produced, hence the effusion

Question 8

Okayyyy, describe a wee flow chart of the pathogenesis of osteoarthritis pls

Answer 8

Muscle weakness/ligament injury/abnormal anatomy -> instability -> increased load -? joint microtrauma -> osteoarthritic joint

Question 9

In the flow chart, what worsens the instability due to muscle weakness/ligament injury/abnormal anatomy?

Answer 9

Obesity

Question 10

How is a diagnosis of osteoarthritis made?

Answer 10

Tends to be >45yrs
Tends to be activity related joint pain plus NO morning stiffness lasting more than 30mins (this is characteristic of inflammatory arthritis)

Question 11

Making sure that makes sense- what is one of the biggest differences in presentation of osteoarthritis and inflammatory arthritis?

Answer 11

Inflammatory arthritis will involve prolonged morning stiffness

Question 12

Which different factors influence how a patient responds to osteoarthritis or other MSK injuries?

Answer 12

Social support
Occupation support
Mood

Question 13

What are some of the non-pharmacological treatments for osteoarthritis?

Answer 13

Thermotherapy
Electrotherapy
Aids and devices
Manual therapy e.g. massage or physio

Question 14

What are some of the pharmacological treatments for osteoarthritis?

Answer 14

Oral analgesia e.g. paracetamol or NSAIDs
Topical treatments

Question 15

When do osteoarthritis patients get referred to surgery?

Answer 15

Substantial impact of QoL
Not responsive to non-surgical treatment