Osteoarthritis (OA) Flashcards
Definition
Synovial joints degeneration shows as loss of articular cartilage, remodelling of the bone and osteophytes formation with mild synovitis. Causes functional limitation and reduced quality of life.
More common with increasing age.
Articular cartilage = smooth, white tissue that covers the ends of bones where they come together to form joints. Loss = bones rub together
can affect any joint most common: knees, hips, small hand joints.
Signs and Symptoms
Symptoms vary between people and different affected joints.
Diagnosis
OA can be diagnosed clinically without investigations if a person:
* is 45 or over and
* activity-related joint pain and
* either no morning joint-related stiffness or morning stiffness that lasts less than 30 minutes.
Otherwise imaging may be used MRI, CT etc
NON Pharmacological Treatment
Weight reduction, regular exercise, use of assistive devices such as a walking stick, TENS (pain relief), Manual therapy (knee/Hip OA + Exercise),
Pharmacological Treatment
Topical NSAIDs for Knee OA. but consider in other joints.
If topical ineffective/unsuitable, consider an oral NSAID and take account of:
- potential GI, renal, liver and CV toxicity
- any risk factors the person may have = age, pregnancy, current medication and comorbidities.
Offer a gastroprotective treatment (PPI) if on long term ORAL NSAID.
Paracetamol or weak opioids should only be used infrequently for short-term pain relief if all other drug treatments are unsuitable/FAIL
Intra-articular corticosteroid injections can be considered to provide short-term relief when others FAIL.
Topical capsaicin 0.025% may provide relief of pain in some patients, particularly where there is knee involvement.
1 NSAID at a time unless required.
OA (table in pack)
Osteoarthritis (OA)
(Age at which it starts)
It usually begins later in life
(Speed of onset)
Slow, over years
(Joint symptoms)
Joint’s ache and may be tender but have little or no swelling
(Pattern of joints that are affected)
Symptoms often begin on one side of the body and may spread to the other side. Symptoms begin gradually and are often limited to one set of joints, usually the finger joints closest to the fingernails or the thumbs, large weight-bearing joints (hips, knees etc.) or the spine
(Duration of morning stiffness)
Morning stiffness lasts <1 hour. Stiffness returns at the end of the day or after periods of activity
(Whole body symptoms?)
Not present
Referral and follow up
Follow up only when needed:
Treatments need monitoring, persons ability to seek help, occupation and activities, severity of symptoms and limitations functionally.
Referral:
Consider referring people with hip, knee or shoulder OA for joint replacement if:
- Symptoms (like pain, stiffness, reduced function or progressive joint deformity) are badly impacting their quality of life AND
- non-surgical management is ineffective or unsuitable.
