Osteoarthritis and Principles of Management

Question 1

What percentage of the UK population over 60 are affected by osteoarthritis symptoms?

Answer 1

More than 50%

Question 2

What members of the MDT are involved in osteoarthritis management?

Answer 2

GP
Nurse
Patient
Dietician
OT
Physiotherapist
Orthopaedic surgeon 
Physician

Question 3

What is osteoarthritis?

Answer 3

Tear, flare and repair
Trauma and mechanical imbalance
Inflammation and pain
Repair process around the joint

Question 4

What are the biomechanical factors causing osteoarthritis?

Answer 4

Abnormal anatomy 
Intra-Articular fracture 
Ligament rupture 
Meniscal injury 
Occupation 
Persistent heavy physical activity 
Elite running 
Obesity

Question 5

What are the features of inflammation in osteoarthritis?

Answer 5

Synovial hypertrophy
Subchondral changes
Joint effusion

Question 6

What biochemical mediators is OA associated with?

Answer 6

IL-1 beta
TNF alpha
MMPs

Question 7

What is the pathogenesis of OA?

Answer 7

Muscle weakness, ligament injury, abnormal anatomy
Obesity, instability/malalignment 
Increased load 
Joint micro-trauma 
Synovitis, osteoarthritic joint

Question 8

What are the clinical features of OA?

Answer 8

Pain 
Stiffness
Crepitus
Swelling 
Reduced range of movement 
Heat at affected joint 
Effusions

Question 9

How is OA diagnosed?

Answer 9

45+ years 
Activity-related joint pain plus;
- no morning joint related stiffness
or 
- morning stiffness that lasts no longer than 30 minutes 

Limping, walking aids, slow pace

X-ray

Question 10

What are the x-ray features of OA?

Answer 10

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Remember LOSS

Question 11

What are the risks/red flags of OA?

Answer 11

Trauma - fracture
Prolonged morning-related stiffness
Rapid deterioration of symptoms
Hot, swollen joint

Question 12

What are the differential diagnoses for OA?

Answer 12

Gout
Other inflammatory arhtritides
Septic arthritis
Malignancy

Question 13

What is the management of OA in primary care?

Answer 13

Holistic approach
Self-Management
Information, exercise and weight loss
Pharmacological and non-pharmacological treatments
Referral for consideration of joint surgery

Question 14

What are the non-pharmacological treatments of OA?

Answer 14

Aids and devices - OT, adaptations at home
Manual therapy - physio, self-help
Thermotherapy
Electrotherapy
Dietician - weight loss will prevent further damage and reduce amount of pain but will not reverse damage which has already been done

Question 15

What are the pharmacological treatments of OA?

Answer 15

Oral analgesia - NSAIDs, paracetamol 
Topical treatments - NSAIDs, capsaicin
Steroid injections 
- reduce inflammation in joint 
- can be diagnostically useful

Question 16

What is the management of ongoing joint pain in OA?

Answer 16

Consider problem in joint above/joint below as pain might be referred and cause might be missed
Consider joint replacement surgery

Question 17

What might be indications for referral for joint-replacement surgery?

Answer 17

Substantial impact on quality of life

Refractory to non-surgical treatment

Question 18

What should patients be aware of when considering joint replacement surgery?

Answer 18

Joint replacement will not last forever - around 15 years before another replacement is needed
Post-operative pain, stiffness and swelling and need to mobilise the joint
DVT and PE risk
Knee replacement recovery is longer and harder than hip replacement