Osteoarthritis Flashcards
What are the two processes in osteoarthritis?
*degeneration of cartilage
*reparation of bone
When is osteoarthritis more common?
Increasing age
Women
What is the degenerative process of osteoarthritis?
*interleukin-1 released
*leads to nitric oxide production and prostaglandin synthesis- degeneration of cartilage
*synovial cells all release matrix metalloproteinases (MMP’s)
*leads to degeneration of cartilage
*degeneration means any water uptake causes cartilage to swell and split
*forms fissures- cartilage fragments
*leads to narrowing of joint space, or formation of cysts in bone
What is the reparative process?
*increased osteoblast activity
*formation of new bone at periphery of joint- lipping
*bony outgrowth- osteophytes
What are the affected joints in osteoarthritis?
*fingers
*neck
*knees
*hips
*toes
How is osteoarthritis diagnosed?
*symptoms
*radiographic changes
*ACR clinical classification criteria
What are the symptoms/clinical features of osteoarthritis ?
*obese women with two affected knees
*Middle Aged man with one affected hip
*localised pain
*aggravated by motion and relieved by rest
*joints stiffen after rest- gelling
*tender joints
*unstable joints- particularly knee- sideways movement
*bony enlargements
*heat and swelling ABSENT
What are the three categories of disease management?
*general measures- weight control
*specific drugs and physio
*surgery for advanced disease
What drug classes are used in osteoarthritis?
*topical NSAID’s
*oral NSAID’s
*intra-articular corticosteroids (into joint)
What are the benefits of oral NSAID’s?
*decrease gelling
*allow less painful joint function
*allow faster recovery from joint pain after activities
What is the order of drugs offered in osteoarthritis?
*NSAID’s- topical and oral
*intra articular corticosteroids- only if others ineffective or unsuitable OR SUPPORT EXERCISE
*last resort- paracetamol and weak opioids- no evidence of any benefit
*surgery
