Wk 16: Osteoarthritis

Question 1

What are the differences between rheumatoid arthritis + osteo?

Answer 1

• R: swollen inflamed synovial membrane, O: loss of articular cartilage
• Erosion of bone, bone’s end rub together
• Autoimmune, degenerative
• Symmetrical, asymmetrical

Question 2

What are the differences in symptoms between rheumatoid arthritis + osteo?

Answer 2

• R: pain stiffness + inflammation, O: pain + stiffness in movement
• Morning stiffness = > 30 mins, < 30 mins

Question 3

What was the most consistent linkage of OA?

Answer 3

Chromosome 2q13-32:

• IL-1 gene cluster
• Frizzled related protein 3
• Cartilage structural protein matrilin-3

Question 4

Outline the pathophysiology of osteoarthritis

Answer 4

• OA = arthropathy of synovial joints characterised by cartilage loss + periarticular bone response
• Early stage: cartilage develop irregularities at surface + becomes fibrillated
• Deep clefts form in cartilage w/ loss of aggrecan + type II collagen w/in cartilage extracellular matrix
• Chondrocytes clump w/in cartilage, surrounded by intense staining material indicating inc proteoglycan
• Articular joint surface = damage -> loss of joint function

Question 5

Outline the role of synovial fluid + cells in OA

Answer 5

• Fibrillation + erosion of cartilage surface releasing breakdown product into synovial fluid
• Synovial cells ingest product
• Synovial cells release proteinases + proinflammatory cytokines -> upregulates catabolic processes in synovial membrane + cartilage

Question 6

What are osteophytes?

Answer 6

• Bone spurs
• Limit joint space
• Pinch nerves -> painful + debilitating

Question 7

What are the symptoms of osteoarthritis?

Answer 7

• Clicking/cracking
• Mild swelling
• Stiffness
• Pain in joint
• Bone spurs
• Red flexibility

Question 8

What is primary OA?

Answer 8

• No known cause
• Known as idiopathic OA
• Elderly patient
• Most common form

Question 9

What is secondary OA?

Answer 9

• Linked to existing disease: gout, hemochromatosis
• Joint injuries
• Younger patients

Question 10

What are the non-pharmacological management of OA?

Answer 10

• Exercise + manual therapy
• Joint aids
• TENS
• Surgical joint replacement + arthroscopic lavage
• Nutraceuticals

Question 11

What are the pharmacological management of OA?

Answer 11

• Paracetamol -/+ opioids
• Topical NSAIDS
• Oral NSAIDS + PPI
• Capsaicin
• Corticosteroid injection

Question 12

What should you consider if patient is extremely obese?

Answer 12

Gastric bypass surgery

Question 13

What are examples of surgical procedures for OA?

Answer 13

• Joint fusing
• Osteotomy: addition/removal of small bones
• Prosthesis

Question 14

Give examples of dietary supplements and what they do?

Answer 14

• Glucosamine, chondroitin + S- adenosylmethionine
• Stimulate chondrocytes
• Glucosamine sulfate inhibit cartilage enzyme activity

Question 15

What does hyaluronic acid do?

Answer 15

• Initially: support elasticity of joints

- Aids synovial fluid

Question 16

What is the first line treatment of OA?

Answer 16

Paracetamols

Question 17

What is the next line of treatment if paracetamol is ineffective?

Answer 17

• Co-codamol

Question 18

If opioids + paracetamol is ineffective, what must be considered?

Answer 18

• Topical over oral

- Oral/COX 2 inhibitors

Question 19

Corticosteroid

Answer 19

• Intra-articular injection
• Mod to severe pain
• Every 3 months
• Red pain + inflammation

Question 20

What does NICE say about OA?

Answer 20

OA can be diagnosed clinically w/o investigation if > 45 yrs, activity related joint pain AND no morning joint related stiffness/less than 30 mins