Osteoarthritis and Principles of Management

Question 1

Outline the pathogenesis of OA

Answer 1

Tear, Flare and Repair

Muscle weakenss, ligament injury or abnormal anatomy leads to instability (obesity can increase the load further on the joint)

Over time, micro trauma and repair occurs repeatedly

Leads to an osteoarthritic joint and synovitis

Question 2

How does one diagnose OA?

Answer 2

Criteria:

Aged 45+

Activity related pain (with no morning stiffness lasting >30 mins)

History of trauma, hot swollen joints, prolonged etc.

Question 3

What is the differential diagnosis for OA

Answer 3

Gout, Other inflammatory arthritides, septic arthritis, malignancy

Question 4

Outline the non-pharmacological treatment options for OA

Answer 4

Thermotherapy
Electrotherapy
Aids and devices 
Manual therapy 
(NICE doesn't recommend accupuncture etc.)

Question 5

Outline the pharmacological treatment options for OA

Answer 5

Oral analgesia (paracetamol, NSAIDs)

Topical treatments (NSAIDs, capsaicin cream for hands and knees)

Question 6

When first line treatments have failed, what options are there for surgical intervention?

Answer 6

Joint replacement surgery

Question 7

When should surgical intervention for OA be indicated?

Answer 7

Substantial impact of QOL

Refractory to non-surgical treatment (surgery as last resort)

Referral letter