Osteoarthritis and Principles of Management

Question 1

Definition of osteoarthritis

Answer 1

Tear (trauma to the joints and mechanical imbalance), flare (inflammation in the joints and in the synovial tissue in the joints which causes the pain) and repair (the repair processes in the joint creates a cycle of further damage and pain)

Question 2

Biomechanical factors that can contribute to the formation of oestoarthritis

Answer 2

Abnormal anatomy
Intra-articular fracture
Ligament rupture (increased translation of bones) 
Meniscal injury 
Persistent heavy physical damage
Elite running 
Obesity

Question 3

Inflammation in Osteoarthritis

Answer 3

Synovial Hypertrophy
Subchondral Changes - increased joint fluid in the joint space
Joint effusion

Question 4

Pathogenesis of OA

Answer 4

Joint failure occurs when mechanical stresses overwhelm the capacity of articular tissues to resist and repair the damage. Structural failure of the articular cartilage, bone and periarticular tissues can result from abnormal mechanical stresses damaging previously normal tissues.

Question 5

Clinical presentation of OA

Answer 5

Gradual onset of pain

Slight morning stiffness (less than 30 minutes)

Question 6

Clinical signs of OA

Answer 6

Swelling
Crepitation
Hot joint

Question 7

X-ray signs of OA

Answer 7

Loss of the joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 8

Management of OA (non-pharmacological)

Answer 8

Heat therapy, cold therapy

TENS

Question 9

Management of OA (pharmacological)

Answer 9

NSAID’s, paracetamol, joint steroid injection, topical capsaicin

Question 10

Surgical management of OA

Answer 10

Joint replacement therapy only when arthritis is not responsive to pharmacological therapy

Question 11

Pathology of OA

Answer 11

Remodelling of the anatomy of the joint and proliferation of new bone in the form of osteophytes and focal articular cartilage degeneration.