12: Osteoarthritis and Principles of Management

Question 1

what is osteoarthritis?

Answer 1

• a chronic, degenerative joint disease involving the breakdown and eventual loss of the articular cartilage in the joints.

Question 2

risk factors contributing to the development of osteoarthritis include:

Answer 2

• age
• obesity
• previous joint injury
• overuse of joint
• genetics
• bone deformities

Question 3

signs and symptoms of osteoarthritis

Answer 3

• pain in joint during or after use
• stiffness, especially in the morning or after a period of inactivity
• loss of flexibility and ROM
• grating sensation of the feeling of bone rubbing on bone
• formation of bone spurs around affected joint
• Heberden’s nodes (swelling of distal interphalangeal joints)
• Bouchard’s nodes (swelling of the proximal interphalangeal joints)

Question 4

osteoarthritis investigations

Answer 4

• predominantly based on clinical presentation and corroborated by imaging studies
• X-rays (first-line)
• MRI can provide more detailed view of joint
• potentially lab tests to rule out other types of arthritis

Question 5

list some potential imaging findings in a patient with osteoarthritis

Answer 5

LOSS acronym:
- Loss of joint space: cartilage thinning, which is a hallmark of osteoarthritis
- Osteophytes, also known as bone spurs
- Subchondral sclerosis: increased bone density beneath the cartilage, increased whiteness on x-ray.
- Subchondral cysts: fluid-filled sacs that form in the marrow of the bones adjacet to the joint.

Question 6

Management of osteoarthritis involves:

Answer 6

• pain management with over-the-counter pain relievers and NSAIDs. More severe pain may require prescription mediaction, corticosteroid injections, or even opioids.
• physio
• weight control to reduce stress on weight-bearing joints
• in severe cases, joint replacement or joint fusion surgery

Question 7

diagnostic criteria for osetoarthritis

Answer 7

• at least 45 years old +
• activity related joint pain +
• has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes

Question 8

list some non-pharmacological treatments of osteoarthritis

Answer 8

• thermotherapy
• electrotherapy
• aids and devices
• manual therapy
• NICE do not recommen: acupuncture, nutraceutical (glucosamine, chondroitin)

Question 9

when is surgery indicated for osteoarthritis?

Answer 9

• substantial impact on QoL
• refractory to non-surgical treatment
• referral letter