Osteoarthritis and Principles of Management

Question 1

what is the commonest form of joint problem that affects more than half the UK population >60?

Answer 1

osteoarthritis

Question 2

OA results from?

Answer 2

trauma and mechanical imbalance

Question 3

biomechanical factors leading to OA:

Answer 3

• Abnormal anatomy
• Intra-articular fracture
• Ligament rupture
• Meniscal injury
• Occupation – farmers, football players
• Persistent heavy physical activity
• Elite running
• Obesity

Question 4

in OA inflammation results in:

Answer 4

synovial hypertrophy
subchondral changes
joint effusion

Question 5

what are the important biochemical mediators in OA?

Answer 5

IL-1b
TNF-a
MMPs

Question 6

what can lead to instability and malalignment of a joint?

Answer 6

muscle weakness
ligament injury
abnormal anatomy

Question 7

what can lead to increased load in joints?

Answer 7

obesity

instability/malalignment

Question 8

what can lead to joint microtrauma?

Answer 8

increased load

Question 9

typical OA patient

Answer 9

> 45
activity related joint pain
no morning stiffness or that lasting < 30 mins

Question 10

if there is a Hx of trauma, prolonged morning stiffness, rapid deterioration of symptoms, hot swollen joint what may you consider instead of OA?

Answer 10

gout
other inflammatory arthritides
septic arthritis
malignancy

Question 11

non pharmacological treatments of OA

Answer 11

thermotherapy
electrotherapy
aids and devices
manual therapy

Question 12

pharmacological treatments of OA

Answer 12

oral analgesia - paracetamol, NSAIDS

topical treatments - NSAIDs, capsaicin

Question 13

surgical referral for ongoing joint pain

Answer 13

substantial impact on QoL

refractory to non-surgical treatment