Osteoarthritis and Principles of Management

Question 1

What is the most common form of joint problem?

Answer 1

Osteoarthritis

Question 2

How is osteoarthritis described?

Answer 2

• Tear - trauma and mechanical disturbance
• Flare - inflammation and pain
• Repair - repair processes around the joint

Question 3

What are the biomechanics risk factors for OA?

Answer 3

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

Question 4

How does inflammation manifest in OA?

Answer 4

• Synovial hypertrophy
• Subchondral changes - bone thicken below articular cartilage
• Joint effusion

Question 5

What are the biochemical mediators of OA?

Answer 5

• Uncertainty remains

* IL-1𝝱, TNF 𝜶, MMPs

Question 6

What is the pathogenesis of OA?

Answer 6

PATHOGENESIS OF OA

Question 7

What is the criteria for OA diagnosis?

Answer 7

• 45 years +
• Activity-related joint pain PLUS
• Has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes

Question 8

What are signs that the condition may not be OA?

Answer 8

• Trauma
• Prolonged morning-related stiffness
• Rapid deterioration of symptoms
• Hot, swollen joint

Question 9

What are the differential diagnoses for OA?

Answer 9

• Gout
• Other inflammatory arthritides
• Septic arthritis - sudden onset
• Malignancy - sudden increase in pain

Question 10

What investigations are used to diagnose OA?

Answer 10

•X-ray to confirm clinical diagnosis - no changes in early stages

Question 11

Describe the NICE guidelines for OA treatment

Answer 11

OA NICE GUIDELINES

Question 12

Describe the holistic approach to OA

Answer 12

HOLISTIC APPROACH TO OA

Question 13

What are the non-pharmacological treatments for OA?

Answer 13

• Thermotherapy
• Electrotherapy - electrical stimulation particularly to strengthen muscle
• Aids and devices - splint, walking sticks
• Manual therapy - massage, physio
• NICE do not recommend: acupuncture, nutraceuticals (glucosamine, chondroitin)

Question 14

What are the pharmacological treatments for OA?

Answer 14

• Oral analgesia - paracetamol, NSAIDs
• Topical treatments - NSAIDs, capsaicin (knee, hand)
• Intra-articular injections - steroids, (hyularonic acid - NICE on fence, Aberdeen uses it)

Question 15

When is surgical referral appropriate?

Answer 15

• Substantial impact on quality of life

* All other options exhausted

Question 16

What is the general treatment for advanced OA?

Answer 16

•Joint replacement surgery

bones may be moved around in very early stages of the disease

Question 17

Summary of OA

Answer 17

• OA significant cause of morbidity
• Pathogenesis not entirely clear
• Tailor treatment to individual patient
• Consider surgical management when other options exhausted and quality of life is suffering