Osteoarthritis

Question 1

Is the onset of OA gradual or rapid, and from what age does OA onset begin?

Answer 1

Gradual onset from age 40

Question 2

Between what ages does OA incidence increase rapidly?

Answer 2

50-75

Question 3

What percentage of individuals with OA have limited mobility?

Answer 3

80%

Question 4

What percentage of individuals with OA have difficulty performing daily lifestyle activities?

Answer 4

25%

Question 5

Is prevalence and risk of OA higher in men or women?

Answer 5

Women

Question 6

How does change in composition of the articular cartilage due to OA affect it’s susceptibility to physical forces?

Answer 6

Becomes more susceptible to disruption by physical forces, which is why mechanical stress causes joint degeneration

Question 7

How much of a joint does OA degenerate?

Answer 7

Entire joint

Question 8

What cells cause articular cartilage to degrade and reveal underlying bone in OA, and what do they release to cause degradation?

Answer 8

Chondrocytes in areas of stress, that proliferate and release inflammatory mediators that degrade cartilage matrix

Question 9

After the articular cartilage degrades and underlying subchondral bone is revealed in OA, how does new articular cartilage form?

Answer 9

Underlying subchondral bone becomes the new articular cartilage

Question 10

In the process of articular cartilage degeneration and underlying subchondral bone becoming the new articular cartilage, how does this affect the joint space in OA?

Answer 10

Causes joint space narrowing

Question 11

How does subchondral sclerosis occur in OA?

Answer 11

Mechanical stress on underlying subchondral bone (that has become new articular cartilage) grows and hardens

Question 12

How do osteophytes form from the new articular cartilage in OA?

Answer 12

Local bony areas grow into outgrowths/protrusions

Question 13

What factors are released in OA that result in pain and inflammation, and how do the factors stimulate this?

Answer 13

Vascular growth factors stimulate neurovascular development, which causes pain and inflammation in the joint

Question 14

How do bone cysts form in OA?

Answer 14

They form in areas of localised bone necrosis and resorption, which occurs due to stress-induced microfractures in subchondral bone

Question 15

What is subchondral bone?

Answer 15

Bone beneath articular hyaline cartilage

Question 16

How does OA affect the synovial lining, and what is the name of this condition?

Answer 16

Synovitis: inflammation and thickening of synovial lining

Question 17

What is the name of swelling that occurs in OA?

Answer 17

Joint effusion

Question 18

What is the difference between primary OA and secondary OA?

Answer 18

Primary OA arises from non-specific/idiopathic cause

Secondary OA arises from another specific cause

Question 19

Give 3 examples of causes that can lead to secondary OA onset?

Answer 19

Trauma, RA, infection

Question 20

Does OA present in the same way in every joint?

Answer 20

No, presentation of OA depends on type of affected joint

Question 21

What aspect of the knee is affected by OA, and what is the resulting deformity?

Answer 21

Affects weight-bearing inner aspect which narrows joint space, so results in varus deformity, characterised by bow-legged look

Question 22

When does pain occur due to knee OA, and how does it change throughout the day?

Answer 22

Activity-related pain that is worst at night and is relieved by morning due to rest

Question 23

Is elbow OA common in primary or secondary OA?

Answer 23

No, it is rare

Question 24

What 4 movements are painful due to elbow OA?

Answer 24

Elbow flexion, extension, supination, pronation

Question 25

What 3 places can pain arise in due to hip OA?

Answer 25

Thigh, buttocks, groin

Question 26

What 2 activities are difficult due to hip OA?

Answer 26

Walking up and down stairs Putting on shoes

Question 27

What are 2 characteristic features of hand OA?

Answer 27

Heberden's nodes form when osteophytes grow at distal interphalangeal joints Base of thumb is square-shaped

Question 28

What condition can severe development of shoulder OA lead to, that affects the shoulder joint stability and movement?

Answer 28

Rotator cuff tear arthropathy, due to OA causing loss of function in rotator cuff

Question 29

What are the 2 ways in which rotator cuff tear arthropathy is managed?

Answer 29

Total anatomical replacement of rotator cuff Reverse anatomical replacement, so that deltoid moves and positions arm instead

Question 30

Why do OA patients commonly present with disuse atrophy?

Answer 30

Pain has gradual onset and is worsened by movement, so patients avoid movement which causes muscle wasting

Question 31

What 4 X-ray features indicate OA?

Answer 31

Osteophytes subchondral cysts narrowed joint space subchondral sclerosis

Question 32

Is a blood test necessary to diagnose OA?

Answer 32

No, but is useful to exclude differential diagnoses eg. RA, PsA, gout

Question 33

What is the focus of OA management?

Answer 33

Changing lifestyle

Question 34

Why is a long-term physiotherapy plan and exercise implemented for OA management?

Answer 34

To maintain physical function and decrease further degeneration

Question 35

What 2 types of exercise must be included in physiotherapy for OA management?

Answer 35

Local muscle strengthening General aerobic exercise

Question 36

What shoes are beneficial for individuals with knee and hip OA?

Answer 36

Shoes with thick, shock-absorbing soles and no raised heels

Question 37

Give 3 examples of physical aids that are useful to individuals with hip and knee OA?

Answer 37

Walking sticks Walking frames Wheeled walkers

Question 38

Why is occupational therapy useful for individuals with OA?

Answer 38

They add home modifications that can make it easier for individuals to complete daily activities despite limited mobility eg. handrails on stairs

Question 39

Why are medicines used in OA management?

Answer 39

Adjunct (supplementary) alongside core physical management, used for symptomatic relief eg. pain, inflammation

Question 40

What are the 2 first-line therapies for OA management?

Answer 40

Topical NSAIDs Paracetamol monotherapy

Question 41

If topical NSAIDs and/or paracetamol provide insufficient/no symptomatic relief for OA, what medication can be used?

Answer 41

Oral NSAIDs, which can be used in combination with paracetamol

Question 42

If oral NSAIDs are contraindicated in OA management, what medication can be used?

Answer 42

Opioid analgesics, which can be used in combination with paracetamol

Question 43

What medication is beneficial for providing symptomatic relief in hand and knee OA, and when can it be used?

Answer 43

Topical capsaicin can be used in any stage of treatment

Question 44

Why are intra-articular corticosteroid injections provided in OA?

Answer 44

Moderate-severe pain relief caused by inflammation and swelling

Question 45

When is orthopaedic surgery required in OA management?

Answer 45

Severe joint deterioration, and before there is prolonged and established functional limitation and severe pain

Question 46

Are patient-specific factors such as gender, smoking, obesity barriers to referral for orthopaedic surgery?

Answer 46

No

Question 47

What are the 3 requirements to clinically diagnose OA with no other investigations, according to NICE guidelines?

Answer 47

45y or over Activity-related joint pain Either no morning joint-related stiffness, or morning stiffness that lasts no longer than 30 minutes

Question 48

If an obese/overweight person has OA, what intervention is recommended by NICE?

Answer 48

Intervention to encourage weight loss

Question 49

What is arthrodesis surgery?

Answer 49

Any diseased cartilage between two bones is removed and the bone ends are cut off, and connected to another using metal internal fixation, such as screws and plates, then eventually grow into one another and fuse to become one bone

Question 50

What are 2 benefits of arthrodesis?

Answer 50

Durable, provides pain relief

Question 51

What is the disadvantage of arthrodesis?

Answer 51

Need to sacrifice some movement

Question 52

What is the main difference between arthrodesis and arthroplasty?

Answer 52

Arthrodesis causes fusion within the joint Arthroplasty causes replacement within the joint

Question 53

Give 3 examples of types of arthroplastys?

Answer 53

Excision arthroplasty Hemiarthroplasty (replacing half of hip/only femoral head) Total joint arthroplasty (replaces all parts of joint/eg. Femoral head and acetabulum)

Question 54

Give 1 benefit and disadvantage of an arthroplasty?

Answer 54

Keep range of movement Not durable and wears over time

Question 55

What is a trapeziectomy?

Answer 55

Form of excision arthroplasty where trapezium bone at base of thumb is removed, treats thumb base OA and squaring

Question 56

Give 2 benefits and disadvantages of a trapeziectomy?

Answer 56

Durable and preserves range of movement Can cause carpal instability and has long rehab period

Question 57

What is the main factor in deciding whether you should fuse or replace a joint?

Answer 57

The range of motor function in that joint eg. in a joint that is used for a lot of flexion should be replaced

Question 58

Give immediate, early and late complications of an arthroplasty?

Answer 58

Immediate: technical eg. perioperative fracture Early: infection, dislocation (could be constrained or unconstrained) Late: aseptic loosening (bone implant interface), wearing over time

Question 59

Give 2 functions for regular reviews of individuals with symptomatic OA?

Answer 59

Monitor long-term course of OA Review effectiveness and tolerability of treatments for OA

Question 60

What are the 3 conditions that if an individual has one or more, they have annual reviews of their OA?

Answer 60

Other illnesses or conditions Troublesome joint pain, more than one joint affected Taking any drugs for their osteoarthritis