Non-Inflammatory Arthritis Flashcards
Osteoarthritis
Outline the epidemiology of osteoarthritis (OA) (3).
- OA is the most common form of arthritis
- OA is more common in women than in men, with incidence increasing sharply around age 50 years, and levelling off after age 70 years
- Prevalence of OA increases with age
What are the risk factors of osteaoarthritis (OA) (7)?
- Age > 50 years
- Female sex
- Obesity
- Genetic factors
- Knee malalignment
- Physically demanding occupation / sport
- Post trauma / injury
Outline the pathogenesis of osteoarthritis (OA).
The exact aetiology is unknown.
OA is a complex and multi-factorial disease with numerous genetic, biological, and biochemical components that affect the entire joint, including synovium, meniscus (in the knee), periarticular ligaments, and subchondral bone.
Outline the pathophysiology of osteoarthritis (OA) (3).
- Failure in maintaining the homeostatic balance of the cartilage matrix synthesis and degradation, resulting from reduced formation or increased catabolism
- The osteoarthritic process involves not only the cartilage but also other joint structures, resulting in bone remodelling and bone marrow lesions of the subchondral bone, synovial inflammation, capsular stretching and periarticular muscle weakness, and ligament laxity.
- The above elements, in addition to trauma, can lead to focal stress and eventual cartilage loss. This can further alter the joint anatomy, predisposing it to the potentially detrimental effects of mechanical factors and physical activity, by redistributing and increasing the focal loading in the joint
How would a patient with osteoarthritis (OA) present (7)?
- Presence of risk factors
- Pain
-
Functional difficulties
- i.e. knee giving way or locking
- Knee, hip, hand, or spine involvement
- Bony deformities
-
Limited range of motion
- Both active and passive range of joint movement is reduced in moderate to advanced OA, and this is usually associated with pain
- Malalignment
How would pain present in a patient with osteoarthritis (OA)?
Pain
* Pain in weight-bearing joints
* Pain at rest or at night is unusual, except in advanced OA
How would bony deformities present in a patient with osteoarthritis (OA)?
Bony deformities
* These are particularly common in the hands and lead to enlargement of the proximal interphalangeal (PIP) joints (Bouchard’s nodes) and distal interphalangeal (DIP) joints (Heberden’s nodes), as well as squaring at the base of the thumb (the first carpometacarpal joint)
* In advanced knee OA, there may also be new bone formation, causing bony swellings around the knee joint.
How would malalignment present in a patient with osteoarthritis (OA)?
Malalignment
* Bony malalignment is common, particularly in the knee where OA causes both genu valgum (knock-knees) and genu varum (bow-legs)
What investigations are suggested in suspected osteoarthritis (OA) (1st line 3 / consider 5)?
1st line:
* X-ray of affected joints
* Serum CRP
* Serum erythrocyte sedimentation rate (ESR)
Consider:
* Rheumatoid factor (RF)
* Anti-cyclic citrullinated peptide (anti-CCP) antibody
* MRI of affected joints
* USS
* CT
What would an X-Ray of the affected joints show in a patient with osteoarthritis (OA) (3)?
- New bone formation (osteophytes)
- Joint space narrowing
- Subchondral sclerosis and cysts
What would a serum CRP test show in a patient with osteoarthritis (OA)?
Normal
What would a serum erythrocyte sedimentation rate (ESR) test show in a patient with osteoarthritis (OA)?
Normal
What would a rheumatoid factor (RF) test show in a patient with osteoarthritis (OA)?
Negative
What would an anti-cyclic citrullinated peptide (anti-CCP) antibody test show in a patient with osteoarthritis (OA)?
Negative
What is the management of acute osteoarthritis (OA) (1st line 1 / Plus 1 / Consider 1)?
1st line:
* Topical analgesia
Plus:
* Non-pharmacological approaches
Consider:
* Intra-articular corticosteroid injections
