Osteoarthritis

Question 1

Define osteoarthritis

Answer 1

Asymmetrical degenerative disease due to wear and tear of heavily used joints, resulting in loss of cartilage, sclerosis, eburnation of subchondral bone, osteophytes and subchondral cysts

Question 2

Aetiology of osteoarthritis

Answer 2

Mechanical - wear & tear*
- localised loss of cartilage
- remodelling of adjacent bone
- associated inflammation

Primary (idiopathic): no preceding injury to the joint
- Localised: hands, knee, hip, foot
- Generalised: hands and another joint

Secondary: antecedent insult to the joint e.g. congenital abnormality (hip dysplasia), trauma, inflammatory arthropathies, strenuous physical activity

Question 3

Risk factors for osteoarthritis

Answer 3

Age >50
Female
Obesity
Genetics
Manual occupation
Knee malalignment
High bone mineral density

Question 4

Symptoms of osteoarthritis

Answer 4

Joint pain on movement
- Pain in the weight bearing joints (Knee, hip, distal hand, lumbar and cervical spine, Shoulder, elbow, wrist ankle)
- Associated with activities, worse after use
- Better on rest
- Pain at rest or at night is unusual (except in advanced)
Functional difficulties e.g. knee giving way or locking
Early morning stiffness (<30mins, usually 5 mins)
Swelling, some synovitis
Bony deformities on hand (from osteophytes, loss of cartilage, joint laxity)

Question 5

Signs of osteoarthritis on examination

Answer 5

Hands
Bony deformities (tend to be painful)
- Bouchard’s nodes: enlargement of the proximal interphalangeal (PIP) joints
- Heberden’s nodes: Enlargement of the distal interphalangeal (DIP) joints
- Squaring at the thumb base
- Limited range of joint motion
Knee
Malalignment, esp. in the knee
- Genu valgum (knock-knees)
- Genu varum (bow-legs)
- Tenderness
- Crepitus

Antalgic gait (limping due to pain)

Question 6

Investigations for osteoarthritis

Answer 6

NICE: clinical diagnosis

CRP, ESR: raised

X-ray joint:
- Loss of joint space
- osteophytes
- Subchondral cysts
- Subchondral sclerosis
MRI: cartilage loss, bone marrow lesions, meniscal tears

Question 7

Management for osteoarthritis

Answer 7

MDT

Conservative:
- Education
- physiotherapy
- Exercise programmes e.g. resistance training, tai chi, yoga, water based
- Occupational therapy
Medication
1. Analgesia e.g. NSAIDs, opioids
2. Corticosteroid injections
3. Duloxetine

Joint replacement surgery

Question 8

Complications of osteoarthritis

Answer 8

Functional decline and inability to perform ADLs
Spinal stenosis and cervical lumbar OA
Effusion

Question 9

Prognosis for osteoarthritis

Answer 9

Chronic slowly progressive disease, common with advancing age
Most patients continue to have a degree of pain despite treatment
In patients who do not respond to medical and non-medical therapies, total joint replacement provides good long-term pain relief for most people