Osteoarthritis and Principles of Management

Question 1

What does “Tear, flare and repair” mean?

Answer 1

Trauma and mechanical imbalance
Inflammation and pain
Repair processes around the joint

Question 2

What causes OA?

Answer 2

Abnormal anatomy (DDH)
Intra-articular fracture
Ligament rupture
Meniscal injury 
Occupation (footballers/farmers)
Persistent heavy physical activity 
Elite running
Obesity

Question 3

What inflammation processes occur in OA?

Answer 3

Synovial hypertrophy
Subchondral changes
Joint effusion

Question 4

Pathogenesis of OA

Answer 4

1. muscle weakness, ligament injury and abnormal anatomy leading to ……
2. obesity with instability/misalignment leading to…
3. increased load
4. joint microtrauma
5. osteoarthritic joint, synovitis

Question 5

Criteria for diagnosis of OA

Answer 5

45+ y/o
Activity related joint pain PLUS
Has either no morning joint related stiffness or morning stiffness that lasts no longer than 30 mins

Question 6

Attention should be advised to which particular symptoms if present?

Answer 6

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

Question 7

Differential diagnosis of OA

Answer 7

Gout
Other inflammatory Arteritides
Septic arthritis
Malignancy

Question 8

Holistic assessment of a person with OA looks at….

Answer 8

social 
health beliefs and concerns, expectations
current knowledge of OA 
Occupational 
Mood
Quality of Sleep 
Support network 
Other MSK pain 
Attitudes to exercise
Influence of co morbidity 
Pain assessment

Question 9

Treatment of OA

Answer 9

Non-pharmacological 
- thermotherapy
- electrotherapy 
- aids and devices
- manual therapy 
Pharmacological 
- analgesics (paracetomal, NSAIDs)
- topical (NSAIDs, capsaicin (knee, hand))
Surgery for advanced OA

Question 10

What is highly suggestive of OA in the hands?

Answer 10

Thumb symptoms

Herberdens nodes

Question 11

1st line Tx of OA in knee / hand

Answer 11

Pacetomal + topical NSAIDs