osteoathritis

Question 1

what is osteoarthritis ?

Answer 1

chronic, degenerative and progressive condition affecting synovial joints

-occurs when abnormal load placed on normal joint or normal load placed on abnormal joint

Question 2

what are the most common joints affected by OA?

Answer 2

knee
then hio
then hand

Question 3

what is it called when osteoarthritis affects the spine?

Answer 3

spondylysis

Question 4

is multisite pain common with OA?

Answer 4

yes multisite pain is common - knee, hips, hand and feet in 60-80% of cases

Question 5

how common is OA in people aged 55 or more or 75 years or more?

Answer 5

-55 years -44-70%
75 years - 85%

Question 6

what are the biochemical changes to synovial joints that cause OA to occur?

Answer 6

-articular cartilage = water, collagen and proteoglycans
-loss of proteoglycan relative to collagen
-decrease in water content and permeability
-reduction in collagen tensile stiffness and strength

Question 7

what are the unmodifiable risk factors for OA?

Answer 7

-age
-genetics - 40-80%
-local bony changes eg hip dysplasia
-previous joint trauma - eg All injury, intra - articular fracture

Question 8

what are the modifiable risk factors of OA?

Answer 8

-obesity
-job / occupation
-excess physical activity eg pro soccer player

Question 9

what is primary OA?

Answer 9

-idiopathic - spontaneous onset
-small joints eg hand, hip and knee
-may affect more than 1 joint
-strong link with genetics

Question 10

what is secondary OA?

Answer 10

-often specific to one joint
-post inflammatory arthritis eg RA
-post-traumatic eg fracture of tibial plateau

Question 11

what are the clinical symptons/ signs with the diagnosis of OA?

Answer 11

-joint pain - achey
-stiffness - morning within 30 mins NB
-may or may not be crepitus
-bony enlargement
-little or no swelling nB

Question 12

what would you see on a radiological image of OA?

Answer 12

-joint space narrowing
-+/- bony sclerosis
-+/-osteophyte formation

Question 13

what kind of imaging would you use for OA? is it needed?

Answer 13

xray
MRI]

cdiagnosis can be made without imaging

Question 14

are lab results normal with OA?

Answer 14

yes

Question 15

what are the differential diagnoses of OA?

Answer 15

-inlammatory arthritis
-other joint articular disorders eg FAIS, degenerative meniscus injury
-pain referral? eg hip to knee?

Question 16

what joints in the hand are most likely to have OA?

Answer 16

-PIP
-DEIP
thumb CMC

Question 17

describe pain w/ osteoarthritis

Answer 17

-activity related pain - worse at the end of the day or after rest
-eased by movement
-as disease progresses, night pain and rest pain are present

Question 18

cartilage is aneural, so what causes the pain?

Answer 18

lots of other structures within the joint that cause the pain eg muscle, peri-articular structures, ligaments etc
-cartilage dosent case pain

Question 19

how do you test for stiffness in a physical exam?

Answer 19

-passive ROM to get end feel of joint

Question 20

other than pain and stiffness, what are other subjective features that might be seen with OA?

Answer 20

-fatigue - tiredness and exhaustion
-psychological health

Question 21

what examination findings will you get with OA?

Answer 21

-inalmmation / effusion (will be minor in comparison to inflammation arthritis),
-loss of ROM -pain stiffness
-muscle weakness and atrophy
-reduced function - might be specific to body region
-deformity eg kne valgus, varrus, hallux valgus
-joint instability - ligament laxity

Question 22

how do you manage OA?

Answer 22

-combination of non-pharmacological and pharmacological interventions
-curently no cure for OA
-aim is to manage symptoms, reduce deterioration, & enhance quality of life
-self management NB

Question 23

what are the 3 pillars of the core recommended management of OA

Answer 23

-exercise
-education and self management
-weight management

Question 24

what are examples of drugs used for OA? in terms of order

Answer 24

-topical OA - rub on skin- good for patients w/ CV or GI probs
-oral NSAIDS
-intra-articular steroid injections
-paracetamol - no clinical benefit

Question 25

what are the surgeries normally done for OA?

Answer 25

-osteotomy
-arthroplasty eg THR or TKR
-arthrodesis (rare)

Question 26

what does the subjective assessment of OA involve for physios?

Answer 26

-symptoms to body chart
-1 joint or multiple joints
-one or multiple joints?
-pain behaviour - eg 24 hr, eggs or eases
-stiffness - swelling?
-functional difficulty eg stairs, STS walking etc
-history of onset and progression over time
-general health - heart disease, BP, diabetes etc
-investigations - imaging?
-medications taken and effect
-management to date and effect
-knowledge and understanding of OA
-outcome measures - WOMAC, KOOS etc

Question 27

what does the physiotherapy physical assessment of OA involve?

Answer 27

-observation gait, posture , functional difficulties etc
-ROM
-strength
-palpation
-special tests
-physical function / physical performance -squat, Sts, stairs NB, timed tests
-exercise tolerance - eg 6 min walk test
-QOL, psychological health

Question 28

describe the physiotherapy intervention for OA patients

Answer 28

-education - self management and CBT
-exercise therapy - ROM, strengthening, aerobic, hydrotherapy etc
-physical activity prescription
- weight management