Rheumatology - Osteoarthritis Flashcards
Features of OA
• Commonest joint condition
◦ Onset typically >50 years
• Occurs in synovial joints and is characterised by cartilage loss with accompanying periarticular bone response. There is significant inflammation of articular and peri-articular structures and alteration in cartilage structure
Risk factors
- Obesity
- Heredity
- Female > male
- Hypermobility
- Congenital hip dysplasia
- Occupation/sport
Symptoms
- Joint pain
- Joint gelling (stiffening and pain after immobility) - worse at the end of the day
- Joint instability
- Loss of function
Signs
- Joint tenderness
- Crepitus
- Limited RoM
- Joint effusion and variable levels of inflammation
- Bony swelling/wasting of muscle
- Worse at end of day
- Heberden’s nodes: mainly post-menopausal women - affects DIP joints, CMC joints and knees
What are the main sites affected?
• Nodal: joints of hands usually affected one at time over several years- DIPs affected more than POPs
◦ Get Heberden’s nodes (DIP) and Bouchard’s nodes (PIP)
◦ CPC and MCP joints Aldo affected
• Hip: affects 7-25% of white adult Caucasians - most commonly affects weight bearing upper surface of femoral head and adjacent acetabulum
• Knee: affects 40% individuals >75 years old
◦ F>M
What Ix do you do?
- Bloods: no specific test - ESR normal but high sensitivity CRP may be slightly raised. Rheumatoid factor and ANAs are negative
- MRI: can show meniscal tears, early cartilage injury and subchondral bone changes
- X ray: loss of joint space, osteophytes, su articular screams is and subchondral cysts
- Arthroscopy: shows surface erosion of cartilage
What is the Mx for OA?
• exercise to improve muscle strength and general aerobic fitness
• Wt loss
• Analgesia: regular paracetamol +/- topical NSAIDs
◦ Can try topical capsaicin
◦ Intra-articular steroid injections
◦ Intra-articular hyaluronic acid injections
• Surgery: joint replacement (knees/hips) - substantial increase in QoL
