Osteoarthritis (OA)

Question 1

Which joints are affected in OA?

Answer 1

Synovial

Question 2

Name 2 risk factors for developing OA

Answer 2

• Obesity
• Older age
• Occupation i.e. heavy lifting
• Trauma
• Female
• Family history.

Question 3

What is the theorised pathophysiology of OA?

Answer 3

Imbalance between the cartilage being worn down and the chondrocytes repairing it leading to structural issues in the joint

Question 4

What are the 4 key findings on x-ray in OA (LOSS)?

Answer 4

L – Loss of joint space
O – Osteophytes
S – Subchondral sclerosis (increased density of the bone along the joint line)
S – Subchondral cysts (fluid-filled holes in the bone)

Question 5

1) What are the 2 main ways that OA presents?
2) In OA, does activity of the joint make the pain better or worse?
3) Name 2 consequences of longterm OA on joints

Answer 5

1) Joint stiffness and pain
2) Worse
3) Deformity, instability and reduced joint function

Question 6

Name 3 of the commonly affected joints

Answer 6

• Hips
• Knees
• Sacro-iliac joints
• Distal-interphalangeal joints
• The CMC joint at the base of the thumb
• Wrist
• Cervical spine

Question 7

OA signs in the hand
1) In which joints are Heberden’s nodes seen?
2) In which joints are Bouchard’s nodes seen?
3) Name another OA sign in the hands
4) What kind of joints is the carpo-metacarpal joint at the base of the thumb?
5) In this joint, the metacarpal bone of the thumb is sat on what bone?

Answer 7

1) DIP joints
2) PIP joints
3) Squaring at the base of the thumb at the carpo-metacarpal joint, weak grip, reduced range of motion
4) Saddle
5) Trapezius

Question 8

OA can be diagnosed without investigations; name 2 features for a diagnosis

Answer 8

Patient is:
- >45
- Typical activity related pain
- No morning stiffness or stiffness lasting less than 30 minutes

Question 9

Name 2 aspects of the general management of OA

Answer 9

• Patient education i.e. weight loss
• Orthotics
• Physiotherapy
• Walking aids
• Occupational therapy

Question 10

Name 2 options for analgesia used in OA

Answer 10

• WHO ladder
• Steroid injections
• Nerve blocks

Question 11

Name a surgical option for the management of OA

Answer 11

• Arthroscopic debridement
• Joint replacement (arthroplasty)
• Realignment osteotomy
• Arthrodesis (fusion)