Osteoarthritis and Principles of Managment Flashcards
What proportion of the population over 60 has symptoms of osteoarthritis?
> 50%
Briefly describe the pathology of osteoarthritis
Osteoarthritis is defined as “tear, flare and repair”. This means that injury must happen to the joint, followed by an inflammatory response that does not result in complete repair, but partial repair that will lead to degeneration of the joint.
What biomechanical factors contribute to the development of osteoarthritis?
- Abnormal anatomy (DDH)
- Intra-articular fracture
- Ligament rupture
- Meniscal injury
- Occupation – farmers, football players
- Persistent heavy physical activity
- Elite running
- Obesity
What are the physiological complications of osteoarthritic inflammation?
Synovial hypertrophy
Subchondral changes
Joint effusion
What is diagnosis of osteoarthritis based upon?
- Age >45
- Activity-related joint pain
- Morning joint-related stiffness that lasts no longer than 30 minutes (more prolonged morning symptoms is more indicative of rheumatoid arthritis)
What are the most common presentations of osteoarthritis to GP?
Pain
Loss of function
What symptoms are less indicative of osteoarthritis?
- Trauma
- Prolonged morning-related stiffness
- Rapid deterioration of symptoms
- Hot, swollen joint
What is on a differential diagnosis with osteoarthritis?
- Gout
- Other inflammatory arthritides
- Septic arthritis
- Malignancy
What investigation is used in osteoarthritis?
X-ray, with weight bearing x-rays being most helpful
Describe the first line management of osteoarthritis
First step in management is for patients to self-manage their condition to control loss of function and pain. Information, exercise and weight loss would be the next step to minimise progression of disease. Exercise and weight loss is sometimes tricky in osteoarthritis as exercise may be painful for patients. Losing weight will reduce pressure on joints and make any future surgeries safer.
What is the non-pharmacological management of osteoarthritis?
- Thermotherapy
- Electrotherapy
- Aids and devices
- Manual therapy
What is the pharmacological treatment of osteoarthritis?
- Oral analgesia:paracetamol, NSAIDs
- Topical treatments: NSAIDs, capsaicin (knee, hand)
- Intra-articular injections: steroid, (hyaluronic acid)
What are the requirements for referral for surgery for osteoarthritis?
Substantial impact on quality of life
Disease that is refractory to non-surgical treatment
What is the basis of surgical treatment of osteoarthritis?
Joint replacement
