The degenerative joint - osteoarthritis

Question 1

what type of joint does osteoarthritis affect?

Answer 1

synovial joints

Question 2

what contributes to the cost of osteoarthritis?

Answer 2

hip replacements 
knee replacements 
lost days at work 
benefits 
treatments

Question 3

what is osteoarthritis?

Answer 3

an age related dynamic reaction pattern of a joint in response to insult or injury

Question 4

Which part of the synovial joint is most affected?

Answer 4

the articular cartilage

but all the tissues of the joint are involved

Question 5

does osteoarthritis have an inflammatory component?

Answer 5

yes and it is a metabolically active and dynamic process mediated by pro-inflammatory cytokines eg IL-1, TNF alpha and NO

Question 6

What are the main pathological features seen in osteoarthritis?

Answer 6

loss of cartilage

disordered bone repair

Question 7

what are the risk factors for osteoarthritis?

Answer 7

age
gender - female 
genetics 
obesity 
occupation 
local trauma 
inflammatory arthritis eg RA 
abnormal biomechanics of the joint eg joint hypermobility, congenital hip dysplasia and neuropathic conditions

Question 8

Explain how age contributes to developing osteoarthritis

Answer 8

cumulative effect of trauma

decline in neuromuscular function

Question 9

How does obesity contribute to OA?

Answer 9

NOT due to mechanical factors
obesity is a low grade inflammatory stage and results in the release of IL-1 and TNF and adipokines - cytokines secreted by adipose tissue eg lectin and adiponectin

Question 10

how does occupation contribute to OA?

Answer 10

manual labour associated with OA of the hands

repeated use of the joints

Question 11

what are the symptoms of OA?

Answer 11

pain, though not always present

functional impairment- can’t walk, ADLs affected

Question 12

what are the signs of OA?

Answer 12

alteration in gait 
joint swelling 
limited range of motion 
crepitus (grating, crackling or popping sounds and sensations experienced under the skin and joints)
tenderness
deformities

Question 13

What contributes to the joint swelling in OA?

Answer 13

bony enlargement
effusion
synovitis (if inflammatory)

Question 14

VIP EXAM

what are the radiological features of OA?

Answer 14

joint space narrowing 
osteophyte formation 
subchondral sclerosis 
subchondral cysts
abnormalities of bone contour

Question 15

What are Heberden’s nodes?

Answer 15

hard or bony swellings that can develop in the distal interphalangeal joints (DIP)

Question 16

What are Bouchard’s nodes?

Answer 16

hard or bony swellings that can develop in the proximal interphalangeal joints

Question 17

Which joints in the hand can OA affect?

Answer 17

DIP
PIP
CMC (eg base of thumb)

Question 18

what is the course of OA of the hand?

Answer 18

relapsing, remitting

Question 19

Which form of OA has a strong genetic component?

Answer 19

nodal form

Question 20

Which is the commonest compartment of the knee to get OA?

Answer 20

medial

Question 21

What are the three compartments of the knee?

Answer 21

medial
lateral
patellofemoral

Question 22

What is the course of OA of the knee?

Answer 22

evolution is slow

once the OA is established, it remains stable for years

Question 23

How does erosive/inflammatory OA present?

Answer 23

pain and swelling of the small joints of the hand
pain worse on exertion but also worse after prolonged rest
morning stiffness lasting longer than usual for degenerative eg 1 hour
bony swelling of the joints but also additional soft tissue swelling
tenderness of the joints

Question 24

What therapy can be used for erosive/inflammatory OA in addition to usual OA therapy?

Answer 24

DMARDs Disease-modifying anti-rheumatic drugs

Question 25

What can cause locking of the knee?

Answer 25

a loose body in the knee - eg bone or cartilage fragment

Question 26

What is arthroscopy?

Answer 26

a type of keyhole surgery used to diagnose and treat problems with joints

Question 27

What are the three ways to manage OA?

Answer 27

non-medical - always tried FIRST!!
pharmacological
surgical

Question 28

Give examples of non-medical ways to manage OA

Answer 28

pt education
activity and exercise 
weight loss
physio
occupational therapy 
footwear
orthoses - a brace, splint, or other artificial external device for support 
walking aids- eg stick or frame

Question 29

What are the pharmacological ways to manage OA?

Answer 29

• topical: NSAIDs and capsaicin (an analgesic)
• oral: paracetamol, NSAIDs, opioids
• Transdermal patches:
  Buprenorphine - longer lasting analgesic than morphine, lignocaine
• intra-articular steroid injections
• DMARDs in inflammatory OA
• herbal/alternative therapies

Question 30

What are surgical ways to manage OA?

Answer 30

arthroscopy - only for loose bodies
osteotomy
arthroplasty
fusion

Question 31

what are the indications for arthroplasty?

Answer 31

uncontrolled pain - particularly at night
significant limitation of function
(some surgeons may not carry it out if the pt is too young, as the replacement will need replacing)

Question 32

When would you refer to a rheumatologist for OA?

Answer 32

• when there is diagnostic uncertainty - they will diagnose OA, but not manage it
• when there is inflammatory osteoarthritis

Question 33

What are the important subtypes of OA?

Answer 33

nodal OA
inflammatory/erosive OA
OA of the knee
OA of the hip