Osteoarthritis + principles of management

Question 1

Provide a definition for osteoarthritis

Answer 1

Trauma and mechanical imbalance. Inflammation + pain. Repair processes around the joint.
(Most common joint condition around world)

Question 2

What is primary osteoarthritis?

Answer 2

Mostly related to aging. With aging, water content of cartilage increases and protein makeup of cartilage degenerates. Repetitive use of joints over years causes cartilage damage that leads to joint pain and swelling.

Question 3

What is secondary osteoarthritis and some of its causes?

Answer 3

Form of OA that is causes by another disease/condition. Conditions that can lead to 2o OA include: obesity, repeated trauma or surgery to joint structures, abnormal joints at birth (congenital abnormalities), gout, diabetes, and other hormone disorders.

Question 4

What are some aetiological factors for osteoarthritis?

Answer 4

Abnormal anatomy (DDH). Intra-articular fracture. Ligament rupture. Meniscal injury. Occupation – farmers, football players. Persistent heavy physical activity. Elite running. Obesity.

Question 5

Describe the pathology of OA

Answer 5

Muscle weakness, ligament injury or abnormal anatomy –> instability/malalignment (+ possible obesity can also lead to…) –> Increased load –> Joint micro trauma –> Osteoarthritic joint; synovitis.

Question 6

Describe the clinical features of OA


Answer 6

Activity related joint pain plus either: no morning related joint stiffness or morning stiffness that lasts no longer than 30 mins.
Be aware of: trauma, prolonged morning-related stiffness, rapid deterioration of symptoms, hot + swollen joint.

Question 7

How would you investigate OA?

Answer 7

Plain radiographs show: LOSS - Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts

Question 8

What non-pharmacological treatment can be used for OA?

Answer 8

Thermotherapy. Electrotherapy. Aids and devices. Manual therapy.

Question 9

What pharmacological treatment can you use for OA?

Answer 9

Oral analgesia: paracetamol, NSAIDs.
Topical treatments: NSAIDs, capsaicin (knee, hand)
Intra-articular injections: steroids, (hyaluronic acid)

Question 10

When would surgery be considered?

Answer 10

Substantial impact on of QOL, refractory to non-surgical treatment, referral letter.
Joint replacement surgery.