Osteoarthritis and Principles of Management Flashcards
intro:
- Osteoarthritis is the __________ form of joint problem
- Symptoms affect more than half the UK population over __
- Massive ____ to the NHS (in terms of support, medication, surgery)
commonest
60
cost
Who manages osteoarthritis?
nurses
patients
physiotherapists
GPs
physicians
dieticians
occupational therapists
orthopaedic surgeons
How do you define osteoarthritis?
Tear, flare and repair”
Tear – microdamage to the cartilage of the joint
Flare – inflammatory response
Repair – attempted repair that goes on over time until damage overcomes the repair mechanism
what is the pathogenesis of osteoarthritis?
- Trauma & mechanical imbalance
- Inflammation & pain (Secondary inflammation and pain and pain is the presenting feature)
- Repair processes around the joint (try to help the damaged articular cartilage repair)
what are some Biomechanical Factors causing osteoarthritis?
- Abnormal anatomy (DDH)
- Intra-articular fracture
- Ligament rupture
- Meniscal injury
- Occupation – farmers, football players
- Persistent heavy physical activity
- Elite running
- Obesity
what happens in inflammation?
- Synovial hypertrophy
- Subchondral changes (bone thickens below articular cartilage)
- Joint effusion
what are Biochemical Mediators?
- Uncertainty remains –
- What drives disease?
- What becomes elevated as a consequence?
- IL-1𝝱, TNF 𝜶, MMPs…
what is the Pathogenesis of OA?
Articular cartilage damage
How do you diagnose osteoarthritis?
- 45 years + (Can get in younger if you have had predisposing trauma or anatomy abnormalities)
- Activity-related joint pain plus
- has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes
Made on clinical grounds
pain is key factor
what things should you look out for and pay attention to in someone presenting?
- Trauma (sudden pain after trauma)
- Prolonged morning-related stiffness (may be inflammatory cause)
- Rapid deterioration of symptoms (not normal in osteoarthritis)
- Hot, swollen joint (osteoarthritics don’t get this)
what are some differential diagnosis?
- Gout (particular around the knee)
- Other inflammatory arthritides (rheumatoid arthritis)
- Septic arthritis (sudden onset, painful to move joint, must rule this out)
- Malignancy (history and examination often has subtle differences)
what investigations may be done?
- Generally with x-ray to confirm clinical diagnosis
- In early stages no x-ray stages, only on MRI but later on you do get x-ray changes
wher eis the most of arthritis dealt with?
Majority are dealt with in the community
Key person managing it is the patient, a lot of self management and involvement in their care
What management strategies and options are available?
Self management in earlier stages
Exercise and weight loss
what is the process of a holistic approach?
Examine osteoarthritis effect on patients social life
What to know what the patient knows, understands and their worries
Controlling expectation is key
What is their sleep like
Support network – what carers are available, isolation due to limitation of activities
Consider co-morbidites as may effect other options that are available and may effect fitness for surgery
For pain there is self help strategies and also analgesics
whata re some Non-pharmacological treatments?
- Thermotherapy (heat applied)
- Electrotherapy (electrical stimulation to strength muscles)
- Aids and devices (splints that support joints in a position to make the less painful but still allow movement e.g. base of thumb arthritis which is commonest in body) (walking sticks)
- Manual therapy (massage, manipulation, physiotherapy)
- NICE do not recommend: acupuncture, nutraceuticals (glucosamine, chondroitin)
what are some Pharmacological treatments?
- Oral analgesia:paracetamol, NSAIDs
- Topical treatments: NSAIDs, capsaicin (knee, hand)
- Intra-articular injections: steroid, (hyaluronic acid)
when do you refer for surgery?
- Substantial impact on quality of life
- Refractory to non-surgical treatment - Work way through all non-surgical treatments e.g. weight loss, physio, exercise, pain killers, walking aids, splints
- Referral letter
what is the main surgery done?
joint replacement surgery
This is main treatment
Right is showing hip replacement
what is shown here?
Arthritis in knee
Yellow is articular cartilage
On inner side there is bare bone where cartilage is lost
what is shown here?
Weight bearing x-ray on left and non weight bearing on right
Pin holes in tibia to suggest they have had previous injury
Squint healed fracture
Arrow is pointing to medial part of joint and it is effectively bone on bone
Wider on later side but there is osteophytes so some arthritis on lateral side
Summary:
- OA significant cause of _________
- Pathogenesis ___ entirely clear
- Tailor treatment to individual _______ (and the problems they are having)
- Consider ______ management when other options exhausted and quality of life is suffering
morbidity
not
patient
surgical
