Rheuma: Osteoarthritis Flashcards
When do these patients feel the most pain?
at night
what kind of tissues is swollen in OA?
bone
are there signs of inflammations such as erythema or warmth in OA?
no
is there is morning stiffness
yes, which lasts less than 30 minutes
are there systemic features in OA?
no
how are ESR and CRP levels in OA?
not elevated
WCC in synovial fluid
low (less than 2000)
which joints are more likely to be hit by OA?
ankles, knees and hips (larger joints)
non-pharmacological options for OA
- physiotherapy
- occupational therapy
- lifestyle changes (weight loss, non-weight bearing exercises)
pharmacological options for OA
- paracetamol
- NSAIDs
- pain patches
- hot and cold packs
- capsaicin cream
- Cymbalta (duloxetine)
- steroid injection (if there is inflammation)
- for superficial joints, you can use topical treatment
- for deep joints, you can use oral or injectable treatments
injectable treatment options for OA
- cortisone
- lubrication
- hyaluronic and chondroitin
- steroid/NSAIDs
- platelet-rich plasma
surgical options for OA
- realigning bones
- joint replacement
- joint fusion
- bunion repair
which population does this affect?
the elderly population as this is due to degeneration and wear-and-tear of the joints
what are the nodes caused by osteophyte deposition called
Bouchard’s node in PIP
Heberden’s node in DIP
pattern of the joints affected
polyarthritic and asymmetrical
risk factors for OA
- age
- family history
- previous trauma
- joint defects
- obesity
what makes the pain worse?
exercise (made better by rest)
other features of the condition
- joint pain
- crepitus
- joint gelling
- joint instability
- limited movement
features on examination
- Heberden’s and Bouchard’s nodes
- squaring of the wrist (prominence of the 1st CMC joint)
Plain Xray cardinal features
Subchondral sclerosis
Osteophytes
Narrowing of joint space
Subchondral cysts
lifestyle changes advice
- diet
- weight loss
- reduce stress over the affected joints
- walking aids
- appropriate footwear
indications for arthroplasty
- symptoms which are not responsive to medical treatment
- radiologically-advanced OA
- patients who are motivated to put effort into rehab
- patients who understand limitations, length of recovery and realistic results of the procedure
contraindications for arthroplasty
- individuals with early symptoms
- minimal changes on xray
- unrealistic expectations
- chronic widespread pain
- chronic narcotic use
- dementia or early cognitive loss
characteristics of OA
destruction and loss of articular cartilage
how is the diagnosis made?
APART FROM THE HISTORY OF USAGE-RELATED JOINT PAIN, AN ELDERLY PATIENT WHO HAS EMS FOR LESS THAN 30 MINUTES
the cardinal signs have to be found on normal plain xray; ultrasound may be used for synovial inflammation, effusion and osteophytosis
when should you consider running more tests?
- younger individuals
- atypical symptoms and signs
- presence of weight loss or constitutional symptoms
