Osteoarthritis and Principles of Management

Question 1

What is the commonest joint problem?

Answer 1

Osteoarthritis

Symptoms affect >50% of 60y+ in the UK

Question 2

Does OA affect males or females more?

Answer 2

Females

Question 3

Define OA

Answer 3

Non-inflammatory degeneration of the joint complex mostly affecting the hip joint, knee and hand joints

Now thought to be an inflammatory component however

Question 4

What is the pathophysiology of OA?

Answer 4

Wear, tear, repair
Trauma and mechanical imbalance –> articular cartilage roughens and thins –> whole joint tries to compensate and tissues become hyperactive leading to:
- osteophytes and underneath bone thickens
- synovium thickens (synovial hypertrophy) and produces more synovial fluid (–> effusions)
- capsules and ligaments thicken and contract to try and compensate for instability

Cartilage flakes off into synovium, type A synoviocytes try to destroy it and recruit inflammatory cells which release pro-inflammatory cytokines –> synovitis

Question 5

What things may contribute to developing OA?

Answer 5

Abnormal anatomy (e.g. developmental dysplasia of the hip)
Intra-articular fracture
Ligament rupture
Meniscal injury
Occupation - farmers, footballs, elite runners Obesity - puts extra strain on joints

Question 6

What are the role of biochemical mediators in OA?

Answer 6

Pro-inflammatory cytokines cause inflammation and either inhibit cartilage production/increase its breakdown

E.g.s - IL1beta, TNFa, MMPs

Question 7

What is the criteria for diagnosis of OA?

Answer 7

45y+ and activity related pain and no morning stiffness/morning stiffness lasts less than 30m

Question 8

What are other clinical features of OA?

Answer 8

Crepitus, restricted RoM, swelling, tenderness over joint

Question 9

How do you diagnose OA?

Answer 9

Clinically

May use XRay to rule out differentials

Question 10

When is it not OA?

Answer 10

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

Question 11

What are differentials for OA?

Answer 11

Gout
Reactive arthritides
Septic arthritis
Malignancy

Question 12

What is the non-pharmacological treatment for osteoarthritis?

Answer 12

Exercise, wt loss
Thermotherapy (hot/cold packs) 
Electrotherapy (TENS)
Aids and devices (e.g. insoles) 
Manual therapy (stretching taught by physios)

Question 13

What is the pharmacological treatment for OA?

Answer 13

Oral analgesia: NSAIDs, paracetamol

Topical analgesia: NSAID, capsaicin

Question 14

When should you refer for surgery in OA?

Answer 14

Substantial effect on QoL

Refractory to non-surgical Rx

Question 15

What kinds of surgery can you offer for OA?

Answer 15

Arthroplasty (replacement of joints, mostly hip and knees)

Arthrodesis (joint fusion)