Osteoarthritis

Question 1

What is OA

Answer 1

A chronic disease characterised by cartliage loss and periarticular change

Question 2

What are the most commonly affected joints

Answer 2

Knees, hands and hips

Question 3

What are some risk factors

Answer 3

Ageing, female sex, obsesity, occupational usage

Question 4

Why are females more commonly affected

Answer 4

As they are more likely to develop osteoporosis

Question 5

What are all the features of an osteoarthritic joint

Answer 5

Subchondral bone cyst, thickened joint capsule, episodic synovitis, fibrillated cartilage, osteophyte, degenerative cartilage loss and subchondral bone sclerosis

Question 6

What is generalised OA

Answer 6

OA at either spinal or hand joints and in at least 2 other joint regions

Question 7

What are Heberden’s nodes

Answer 7

osteophytes/ bone swelling at DIP joints in hand

Question 8

What are Bouchard’s nodes

Answer 8

osteophytes/ bone swelling in PIP joints in hand

Question 9

What is a CMC joint

Answer 9

squaring of thumb, closer to palm than what it should be (associated with poor grip) 1st CMC and trapezoscaphoid

Question 10

What is the presentation in thumb OA

Answer 10

Poor grip

Question 11

What has morning stiffness got to do with OA

Answer 11

Lasting less than 30 minutes

Question 12

How does joint pain change with use

Answer 12

Pain is worse with use

Question 13

What are the examination features

Answer 13

joint line tenderness, crepitus, bony swelling (osteophyte), deformity (valgus/varus in knee) and limitation of motion

Question 14

What is also seen in the knee OA

Answer 14

Baker’s cyst

Question 15

Where is pain from hip OA felt

Answer 15

felt in groin, or radiating to knee or lower back

Question 16

What is the pain associated with cervical spine OA

Answer 16

Occipital headaches are common. Pain and restriction of movement. osteophytes may impinge on nerve roots

Question 17

What is the pain associated with lumbar spine OA

Answer 17

osteophytes can cause spinal stenosis if they encroach on the spinal canal.

Question 18

How is diagnosis done in OA

Answer 18

Clinical based on signs and symptoms

Question 19

What is seen on Xray

Answer 19

Marginal osteophytes.
Joint space narrowing.
Subchondral sclerosis.
Subchondral cysts

Question 20

What are the pitfalls of Xray in OA

Answer 20

insensitive especially in early disease, and correlate poorly with disease activity

Question 21

What is the surgical management in OA

Answer 21

Joint replacements mainly.

Question 22

What is the medical management of OA

Answer 22

Analgesia, rarely steroid injections, physio, OT, education (exercise is important to strengthen muscles around joints!!)

Question 23

What joint has the worst prognosis

Answer 23

Hips

Question 24

What is the natural history of knee OA

Answer 24

third improve, third stable and third deteriorate