Osteoarthritis and Principles of Management Flashcards
What percentage of the UK population over 60 are affected by osteoarthritis symptoms?
More than 50%
What members of the MDT are involved in osteoarthritis management?
GP Nurse Patient Dietician OT Physiotherapist Orthopaedic surgeon Physician
What is osteoarthritis?
Tear, flare and repair
Trauma and mechanical imbalance
Inflammation and pain
Repair process around the joint
What are the biomechanical factors causing osteoarthritis?
Abnormal anatomy Intra-Articular fracture Ligament rupture Meniscal injury Occupation Persistent heavy physical activity Elite running Obesity
What are the features of inflammation in osteoarthritis?
Synovial hypertrophy
Subchondral changes
Joint effusion
What biochemical mediators is OA associated with?
IL-1 beta
TNF alpha
MMPs
What is the pathogenesis of OA?
Muscle weakness, ligament injury, abnormal anatomy Obesity, instability/malalignment Increased load Joint micro-trauma Synovitis, osteoarthritic joint
What are the clinical features of OA?
Pain Stiffness Crepitus Swelling Reduced range of movement Heat at affected joint Effusions
How is OA diagnosed?
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
What are the x-ray features of OA?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Remember LOSS
What are the risks/red flags of OA?
Trauma - fracture
Prolonged morning-related stiffness
Rapid deterioration of symptoms
Hot, swollen joint
What are the differential diagnoses for OA?
Gout
Other inflammatory arhtritides
Septic arthritis
Malignancy
What is the management of OA in primary care?
Holistic approach
Self-Management
Information, exercise and weight loss
Pharmacological and non-pharmacological treatments
Referral for consideration of joint surgery
What are the non-pharmacological treatments of OA?
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
What are the pharmacological treatments of OA?
Oral analgesia - NSAIDs, paracetamol Topical treatments - NSAIDs, capsaicin Steroid injections - reduce inflammation in joint - can be diagnostically useful
What is the management of ongoing joint pain in OA?
Consider problem in joint above/joint below as pain might be referred and cause might be missed
Consider joint replacement surgery
What might be indications for referral for joint-replacement surgery?
Substantial impact on quality of life
Refractory to non-surgical treatment
What should patients be aware of when considering joint replacement surgery?
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
