Osteoarthritis - Zero to Finals

Question 1

What is osteoarthritis?

Answer 1

• “Wear and tear” in joints
• Result of overuse, genetic factors and injury
• Occurs in synovial joints (hips, knees)
• Distal interphalangeal hand joints
• Carpometacarpal joint at base of thumb

Question 2

What are the four key x-ray changes in osteoarthritis?

Answer 2

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

Question 3

How does osteoarthritis present?

Answer 3

• Joint stiffness and swelling
• Worsens with activity / at end of day
• Crepitus (crackle) on movement
• Bulky, bony enlarged joint
• Restricted range of motion
• Effusions (fluid) around joint

Question 4

What are the signs of osteoarthritis in hands?

Answer 4

• Herberden’s nodes (bony growths on DIP)
• Bouchard’s nodes (on proximal interphalangeal joints)
• Squaring at thumb base (carpometacarpal joint)
• Weak grip
• Reduced range of motion

Question 5

What is the joint at the base of the thumb, and what type of joint is it?

Answer 5

• Carpometacarpal joint
• Saddle joint
• Metacarpal bone sitting on trapezius bone, using it as saddle
• Lots of use, prone to wear

Question 6

What are the NICE guidelines for a diagnosis of osteoarthritis?

Answer 6

Diagnosis w/o investigations if:
- Pt > 45
- Typical pain associated with activity
- No morning stiffness (or stiffness lasting under 30 minutes)

Question 7

What are non-pharmacological managements for osteoarthritis?

Answer 7

• Therapeutic exercise to improve strength & function, reduce pain
• Weight loss (if overweight), reduce load on joint
• Occupational therapy to support activities and function (e.g. walking aids, adaptations to the home)

Question 8

What are pharmacological managements of osteoarthritis?

Answer 8

• Topical NSAIDs (ketoprofen, diclofenac for knee osteoarthritis)
• Oral NSAIDs where required (co-prescribed with PPI for gastroprotection)