Osteoarthritis: management

Question 1

x

Question 2

x

Question 3

Risk factors:

Answer 3

Previous trauma of a joint increases the risk of having OA in that joint

Obesity

Hypermobility of a joint increases the risk of OA in that joint

Occupation e.g. cotton workers and farmers are more susceptible to hand OA

Osteoporosis reduces the risk of OA

Question 4

x

Question 5

features of OA

Answer 5

Bilateral: Usually one joint at a time is affected over a period of several years.
The carpometacarpal joints (CMCs), distal interphalangeal joints (DIPJs) are affected more than the proximal interphalangeal joints (PIPJs)

Stiffness
worse after long periods of inactivity e.g. waking up in the morning
stiffness lasts only few minutes compared to the morning joint stiffness seen in rheumatoid arthritis

Painless nodes (bony swellings)
Heberden’s nodes at the DIP joints
Bouchard’s Nodes at the PIP joints

Squaring of the thumbs: Deformity of the carpometacarpal joint of the thumb resulting in fixed adduction of the thumb

Question 6

x

Question 7

x

Question 8

x

Question 9

x

Question 10

x

Question 11

Osteoarthritis: general management

Answer 11

help with weight loss,
given advice about local muscle strengthening exercises and general aerobic fitness

Question 12

osteoarthritis Mx first line

Answer 12

paracetamol and topical NSAIDs are first-line analgesics. Topical NSAIDs are indicated only for OA of the knee or hand

Question 13

OA second-line treatment is

Answer 13

NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids

Question 14

non-pharmacological treatment options include

Answer 14

braces, TENS and shock-absorbing insoles or shoes