L06: Osteoarthritis And Septic Arthritis

Question 1

What is osteoarthritis

Answer 1

Non inflammatory condition characterised by the destruction of articular cartilage and formation of new bone

Question 2

What type of joints does osteoarthritis commonly affect

Answer 2

Large joints e.g hip, knee, spine

Question 3

What are the risk factors for osteoarthritis

Answer 3

Poor posture
Obesity 
Joint intensive sports
Occupation
Previous injury to a joint
Family history 
Age and gender

Question 4

What is the presentation of osteoarthritis

Answer 4

Joint pain
Swelling
Stiffness
Only one or 2 joint involved

Question 5

When is the pain worse in osteoarthritis

Answer 5

On movement and is worse with rest

Question 6

What are the features of osteoarthritis on large joints on x-ray

Answer 6

Narrowed joint space
Subchondral sclerosis
Synchondral cysts
Osteophytes
Intra articular loose bone

Question 7

What are the features of a small joint osteoarthritis on x-ray

Answer 7

Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes
Haberdens nodes  
Bouchard nodes

Question 8

What is a haberdens nodes

Answer 8

Swelling of DIPJ

Question 9

What is a Bouchard node

Answer 9

Swelling of PIPJ

Question 10

What are the differences of osteoarthritis and rheumatoid arthritis

Answer 10

Osteoarthritis:
Pain worse with exercise 
Morning stiffness lasts 30-60mins
Over the age of 50
Bouchard and haberdens nodes

Rheumatoid arthritis:
Pain worse with rest 
Morning stiffness lasts more than 1 hour
Pain improves with movement 
Age between 20-40
Heberdens nodes is absent due to DIPJ sparing 
General systemically unwell

Question 11

What are the x-ray features of ra

Answer 11

Sparing of DIPJ (no haberdens nodes)
Peri articular erosions
Bone erosion
Subluxation
Deformity (swan neck and boutonnière)
Ulnar deviation

Question 12

What is the management of osteoarthritis

Answer 12

Conservative: weight loss, exercise, physiotherapy
Pharmacological: analgesia, corticosteroid injection to the joint
Surgical: resurfacing the joint, osteotomy and joint replacement

Question 13

What is septic arthritis

Answer 13

Infection of a joint caused by pathogen inoculation

Question 14

How can bacteria enter the joint

Answer 14

Wounds
Surgical incision
Blood stream

Question 15

Which common organism is likely to cause septic arthritis

Answer 15

Staphylococcus aureus

Question 16

What is the presentation of septic arthritis

Answer 16

Pain
Septic
Fever

Question 17

On examination how does the joint appear in septic arthritis

Answer 17

Red
Swollen
Warm
Tender
Inability to weight bear 
Inability to tolerate passive movement 
Extremity held in position to maximum joint volume

Question 18

What are the investigations carried out in septic arthritis

Answer 18

FBC: white blood ell count, CRP and serum uric acid

Question 19

What does a raised white cell count, high CRP and normal uric acid suggest

Answer 19

Infective joint

Question 20

What does a normal white cell count, high CRP and high uric acid acid suggest

Answer 20

Gout

Question 21

What other investigations can be carried out

Answer 21

Joint aspirate for: appearance, microscopy, culture, crystal analysis

Question 22

What is the management of septic arthritis

Answer 22

Intravenous antibiotic therapy

Surgical (gold standard): washing joint and then commencing antibiotic therapy