Osteoarthritis Flashcards
What is osteoarthritis?
non-inflammatory arthritis
-wear and tear
What are the characteristic x-ray changes in osteoarthritis?
L – loss of joint space
O – osteophytes
S - sclerosis
S – subchondral cysts
What is the pathogenesis of osteoarthritis?
- loss of cartilage matrix
- fibrillation and attempted repair with osteophyte formation then occurs
What is the difference between idiopathic and secondary osteoarthritis?
IDIOPATHIC
Localised – hands, feet, knee, hip and spine. Other joints less commonly affected
Generalised – Involvement of three or more sites
SECONDARY Previous injury Rheumatoid arthritis Genetic elements Acromegaly Calcium crystal deposition disease
what are some causes of secondary osteoarthritis?
Congenital dislocation of the hip
Perthes SUFE Previous intra‐articular fracture Extra‐articular fracture with malunion Osteochondral / hyaline cartilage injury Crystal arthropathy Inflammatory arthritis (can give rise to mixed pattern arthritis) Meniscal tears Genu Varum or Valgum
What are the risk factors for osteoarthritis?
Age Female versus male sex • Obesity Occupation Sports activities Previous injury Muscle weakness
What are the symptoms of osteoarthritis?
Pain – typically worse on activity and relieved by rest. May progress to be present with less activity and at rest or at night.
Stiffness – usually morning stiffness lasts less than 30 mins. Inactivity gelling. worse after effort. evening stiffness
What general examination findings are found in osteoarthritis?
Joint tenderness
Joint effusion
Crepitus
Bony enlargements due to osteophytes
-joints feel hard and bony
What is seen in the hands in osteoarthritis?
DIP, PIP and 1st CMC joints
Bony enlargements may be seen at DIPs (Heberdens nodes) and PIPs (Bouchards nodes)
Squaring of the thumb
What is seen in the knee with osteoarthritis?
Osteophytes, effusions, crepitus and restriction of movement
Genu varus and valgus deformities
Bakers cyst
What is seen in the hip in osteoarthritis?
Pain may be felt in groin or radiating to knee
Pain felt in hip may be radiating from the lower back.
Hip movements restricted
What is seen in the spine in osteoarthritis?
Cervical – pain and restriction of movement
Osteophytes may impinge on nerve roots
Lumbar – osteophytes can cause spinal stenosis if encroach on spinal canal
What are the non-pharmalogic treatment for osteoarthritis?
Explanation - not because of overuse
Physiotherapy- muscle strengthening, proprioceptive
‘Common sense measures’ - weight loss exercise, trainers, walking stick
What are the pharmologic treatment of osteoarthritis?
Analgesia – paracetamol, compound analgesics, topical anagesia
NSAIDs - may give additional symptomatic relief, consider risk/benefit ratio
Pain modulators – tricyclics eg. amitriptyline, anti-convulsants eg. gabapentin
What intra-articular therapies exist for osteoarthritis?
Steroids
Hyaluronic acid
