Osteoarthritis Flashcards
Which factors contribute to OA?
- Joint integrity
- Genetics (eg correlation 2 fold higher in identical twins)
- Local inflammation
- Mechanical forces
- Metabolic processes
- Biomechanics
What are the functions of chondrocytes?
- Collagen synthesis
- Degradation of matrix
- Proliferation
Explain the role of obesity in development of OA
- Biomechanics: excessive load
- 25% of UK pop.
- expected to reach 40% in next decade
- Associated with OA at many sites
- Knee(8 fold increased risk)
- Hip(not in every study)
- Hand( 3 fold increased risk)
Which gender is more likely to get OA and why
Female
- 3 fold increased chance
- ‘menopausal’ arthritis is a well-recognised phenomenon
- Hormonal; factors thought to play a role (oestrogen therapy may be protective)
- Curiously there is a negative correlation between osteoporosis and OA
What are the risk factors of OA?
- Female
- Obesity
- Previous injury
- Genetic factors
- Age>40
What are the symptoms of OA?
PAIN (despite cartilage being aneural):
- Typically exacerbated by activity & relieved by rest
- With more advanced disease, pain occurs with progressively less activity, eventually occurring at rest & at night
INACTIVITY GELLING is common, but morning stiffness usually lasts< 30mins
What examination findings may be present in OA?
- Classic distribution: ( usually affects the fingers, knees, hips& spine; rarely affects the elbows, wrists, or ankles)
- Joint tenderness
- Bony enlargement
- Effusions
- Crepitus
Outline the radiographic features of OA
- Joint space loss
- Joint line sclerosis
- Osteophytes
- Subchondral cysts
What categories of treatments are there for OA?
- Weight loss(reduces symptoms and slows progression)
- Physiotherapy(involving range of movement & isometric strengthening; braces in some circumstances)
- Pain relief
- Joint replacement
Outline the pharmacological treatments for OA
- first line= Topicals-capsaicin
- Paracetanol
- NSAIDs/COX 2
- Intra-articular steroid
Additional notes=
- co-prescribe PPI with NSAIDs/COX2
- Caution with use of NSAIDs alongside low dose aspirin
According to NICE, what shouldn’t be offered for an OA pt?
- Glucosamine or chondroitin
- Intra-articular hyaluronan
Outline the affect of arthroscopy/joint wash out
- Short term benefits only
- Not superior to either sham procedure or physiotherapy
When should a pt be referred for surgery?
- When OA is having an impact on QOL despite non-surgical treatments(rather than based on radiographic or other scoring tools)
- Refer before there’s prolonged and established functional limitation & severe pain
- Patient-specific factors (age,sex,smoking, obesity& co-morbidities) should not be barriers to referral
Outline the characteristics of joint replacement
- Primary indication is pain relief
- VTE(with prophylaxiis) 1%
- 1 year mortality
- 10 year survival of replacement:
- under 55yrs=83%
- over 70yrs=90%
