Orthopaedics

Question 1

Who gets osteoarthritis?

Answer 1

Age>50
Women
Obese
Family history
Physical/manual occupation

Question 2

What are the physiological changes in osteoarthritis?

Answer 2

Destabilisation of normal degradation and synthesis of articular cartilage chondrocytes, extracellular matrix and subchondral bone. Entire joint involvement. Loss of cartilage, sclerosis and eburnation

Question 3

What are the key presenting features of osteoarthritis?

Answer 3

Pain-typically worse with activity
functional difficulties
involve knee, hip, hand or spine
limited range of motion
deformity
instability

Question 4

What would be found on examination (in the hands) of a patient with osteoarthritis?

Answer 4

haberdens nodes in DIP
bouchards nodes in PIP
squaring at base of thumb
weak grip.

Question 5

What diagnostic tests would be carried out on a patient with suspected osteoarthritis?

Answer 5

X-ray-loss of joint space, osteophytes, subarticular sclerosis (increased density alon joint line), subchondral cysts (fluid filled holes in bone)
serum CRP (due to possibility of inflammatory arthritis)
serum ESR (due to possibility of inflammatory arthritis).

Also consider:
rheumatoid factor
anti-cyclic citrullinated peptide (anti-CCP) antibody
MRI (used to rule out other aetiologies such as avascular necrosis or bone tumours)

Question 6

What is the treatment for a patient with osteoarthritis?

Answer 6

Joint replacement surgery.
Physiotherapy, occupational therapy

First line-local analgesia (capsaicin topical or methylsalicylate or diclodenac topical). Physiotherapy.
Intra-articular corticosteroid injections (methylprednisolone acetate or triamcinolone acetonide)-temporary for acute exacerbation

Second line-add paracetamol

Third line-add NSAID

Fourth line-add opioid