T&O: OA

Question 1

Outline the pathophysiology of an OA

Answer 1

Progressive loss of articular cartilage and remodelling of the underlying bone = active response of chondrocytes in the articular cartilage and the inflammatory cells in the surrounding tissues

release of enzymes from these cells break down collagen and proteoglycans, destroying the articular cartilage

exposure of the underlying subchondral bone results in sclerosis, followed by reactive remodelling changes that lead to the formation of osteophytes and bone cysts

Question 2

Outline the aetiology of an OA

Answer 2

Systemic = >45, female, genetics, vit D def

Local = obesity, trauma, anatomical abnormalities, muscle weakness/myopathy, joint laxity, high impact sports

Question 3

What are the symptoms of an OA

Answer 3

Symptoms made worse with activity but relieved by rest

Most common joints affected by osteoarthritis are the small joints of the hands and feet, the hips, and the knees

Pain

Stiffness

Swelling

Joint effusion

Reduced ROM

Crepitus

Muscle wasting

Joint malalignment

Fixed deformity

Back pain

Stooped posture

Ataxic gait

Leg length discrepancy

Question 4

How would you investigate an OA

Answer 4

Bloods = rule out infection, RA

X-ray = SONS

Question 5

How would you manage an OA

Answer 5

Weight loss

Heat/ice packs

Physiotherapy

Analgesia

Topical NSAIDs

Steroid joint injections

Surgical = arthroplasty, arthroscopy, or osteotomy

Question 6

What are the X-Ray features of an OA?

Answer 6

S= Subchondral sclerosis
O= Osteocytes
N= Narrowing of joint space
S= Subchondral cysts