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T&O Surgery > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

Where does osteoarthritis occur?

A

Synovial joints

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2
Q

What are some general risk factors of osteoarthritis?

A

Genetic factors

Overuse

Injury

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3
Q

What is the mechanism of osteoarthritis (simply)?

A

Imbalance between cartilage damage and the chondrocyte response leading to structural issues

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4
Q

What risk factors are there for osteoarthritis?

A

Obesity
Age
Occupation
Trauma
Female
Family history

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5
Q

What joints are commonly affected in osteoarthritis?

A

Hips

Knees

Distal interphalangeal

Carpometacarpal at the base of the thumb

Lumbar spine

Cervical spine (cervical spondylosis)

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6
Q

What key changes can be seen on x-ray in osteoarthritis?

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts (fluid-filled holes in the bone)

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7
Q

Label the image

A
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8
Q

What is important to consider when taking x-rays with osteoarthritis?

A

X-ray may show degenerative findings but patient may be absolutely fine and vive.

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9
Q

How do patients with osteoarthritis present?

A

Joint pain and stiffness

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10
Q

When is joint pain and stiffness worse?

A

Worsens with activity

End of the day

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11
Q

How are presentations of osteoarthritis different from rheumatoid arthritis?

A

Osteoarthritis
Worse after activity and in the evening

Rheumatoid arthritis
Better after activity and worse in the morning

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12
Q

What signs of the joint indicate osteoarthritis?

A

Bony enlargement of the joint

Reduced range of motion

Crepitus on movement

Joint effusion

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13
Q

What are the signs of osteoarthritis in the hands?

A
  • Heberden’s nodes (DIP)
  • Bouchard’s nodes (PIP)
  • Squaring (base of the thumb, CMC)
  • Weak grip
  • Reduced range of motion
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14
Q

What type of joint in the CMC at the base of the thumb?

A

Saddle joint

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15
Q

Why is the CMC joint at the base of the thumb prone to wear?

A

Gets a lot of use as its sits on the trapezium like a saddle and is constantly in contact

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16
Q

Why is it important to look at adjacent joints in osteoarthritis?

A

Referred pain

Patients can present with referred pain especially in adjacent joints

So if a patient has lower back or knee pain look at the hip

17
Q

What are the NICE guidelines for osteoarthritis diagnosis?

A

Diagnosis can be made without investigation if patient is over 45 and has typical pain with activity and no morning stiffness (over 30 minutes)

18
Q

What is the non-pharmacological management of osteoarthritis?

A

Patient education
Lifestyle changes

19
Q

What are some examples of lifestyle changes which are recommended for osteoarthritis?

A

Therapeutic exercise - improve strength and function and reduce pain

Weight loss- reduces joint load

Occupational therapy- support activities and function e.g. walking stick

20
Q

What is the pharmacological management of osteoarthritis?

A

Topical NSAIDs first-line for knee

Oral NSAIDs must prescribe a PPI

21
Q

Why do you need to prescribe a PPI with long-term oral NSAID use?

A

Gastroprotection

Inhibits COX-1 resulting in reduced prostaglandins in the stomach so stomach acid is out of balance thus it must be reduced to not damage stomach mucosa

22
Q

Are opioids used for osteoarthritis?

A

Weak opioids and paracetamol are only for short-term infrequent use

Do not use strong opioids

23
Q

How long can intra-articular steroid injections be used for?

A

10 weeks

24
Q

What oral NSAIDs are used for osteoarthritis or MSK pain?

A

Ibuprofen (first-line)
Naproxen

25
Q

Why must oral NSAIDs be used cautiously in older patients?

A

More likely to be on anticoagulants such as:
- Aspirin
- DOACs (e.g. apiXaban -acts on factor Xa)

26
Q

GI side effects of NSAIDs?

A

Gastritis
Peptic ulcers

27
Q

Renal side effects of NSAIDs?

A

AKI e.g. acute tubular necrosis

CKD

28
Q

Cardiovascular side effects of NSAIDs?

A

Hypertension
Heart failure
MI
Stroke

29
Q

Respiratory side effects of NSAIDs?

A

Exacerbating asthma

30
Q

Why are opioids not used with chronic pain?

A

Little evidence to suggest they help with chronic pain

Side effects such as tolerance, dependence and withdrawal

31
Q

How do NSAIDs cause hypertension?

A

COX 1 inhibitor which results in reduced prostaglandin production

Prostaglandins cause vasodilation, reduced vasodilation results in increased blood pressure

T&O Surgery (34 decks)

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