Osteoarthritis and Principles of Management Flashcards

1
Q

How common is osteoarthritis?

A

Commonest form of joint problem

Affects more than half of the UK population over 60

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2
Q

Describe the pathogenesis of osteoarthritis

A
  • Trauma due to mechanical imbalances causes injury to articular cartilage
  • Inflammation and pain in response to injury
  • Ongoing repair processes around the joint (eventually overwhelmed by extent of injury)
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3
Q

What are some biomechanical factors that lead to the development of osteoarthritis?

A
  • Abnormal anatomy (esp. of hip)
  • Intra-articular fracture
  • Ligament rupture (ACL) / meniscal injury
  • Persistent heavy activity (sports / runners)
  • Obesity
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4
Q

What changes are seen in the joint during the inflammatory component of osteoarthritis?

A
  • Synovial hypertrophy
  • Subchondral changes: thickening of subchondral bone
  • Joint effusion
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5
Q

Symptoms / signs of osteoarthritis?

A
  • 45+ years old
  • Activity related joint pain
  • Either no morning stiffness, or morning stiffness lasting <30 minutes
  • Gradual symptom worsening, not rapid deterioration
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6
Q

Investigations for confirmation of osteoarthritis?

A

X-Ray (no noticeable changes initially)

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7
Q

What radiographic changes are indicative of osteoarthritis?

A
  • Loss of joint space
  • Osteophytes
  • Subchondral sclerosis
  • Subchondral cysts
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8
Q

What is an important step in determining the treatment plan for patients with osteoarthritis?

A

Holistic assessment of the effect of the condition on the patients daily life:

  • Occupational
  • Social
  • Pain assessment
  • etc.
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9
Q

What are some of the non-surgical, non-pharmacological methods of managing osteoarthritis?

A
  • Lifestyle changes (esp. weight loss)
  • Physio / occupational therapy
  • Aids & devices (splints / walking aids)
  • Thermotherapy / Electrotherapy
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10
Q

What are some pharmacological methods of treating osteoarthritis?

A
  • Oral analgesia: paracetamol / NSAIDs
  • Topical treatments: NSAIDs / capsaicin
  • IA injections: steroids / hyaluronic acid
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11
Q

What are some of the surgical methods of treating osteoarthritis?

A
  • Arthroplasty (eg. hip replacement)
  • Osteotomy: scan the patients joint, make 3D computer model, plan how to cut the bone and design jigs to attach to joint - corrects malalignment)
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12
Q

When is surgery done on osteoarthritic patients?

A

When QOL is being significantly affected and all other treatment options have been exhausted

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