Osteoarthritis

Question 1

define

Answer 1

most common type of arthritis.

progressive degenerative condition affecting joints due to an imbalance of cartialge breakdown and repair, with gradual thinning of cartilage, loss of joint space and formation of osteophytes

Question 2

osteophytes

Answer 2

bony spurs

Question 3

inflammation?

Answer 3

there may be inflammation alongisde it, which can lead to flare ups periodically

Question 4

risk factors

Answer 4

• environmental factors, hobbies and occupation may have an influence
• joints with abnormal alignment eg hypermobility, genu, fracture malunion
• previous injuries
• women
• age
• obesity
• familial factors
• genetics
• RA, gout, acromegaly

Question 5

what can previous injuries cause

Answer 5

secondary OA

Question 6

describe the pattern of joint involvement

Answer 6

usually asymmetrical and affects weight bearing or active joints

Question 7

pathogenesis

Answer 7

• A combination of muscle weakness and ligament imbalance leads to uneven load at joint.
• Joint microtrauma causes release of cytokines (including IL-1 and TNF and metalloproteinases) – catabolic factors for cartilage ECM. This causes inflammation of the synovium and abnormal bone remodeling.
• Cartilage consists of predominantly collagen type II fibres linked by covalent bonds, conferring tensile strength
• There is loss of matrix. Fibrillation (softening and development of vertical clefts) of the cartilage surface (progressive loss by abrasion) and attempted repair with osteophyte formation then occurs.

Question 8

describe a joint with mild arthritis

Answer 8

osteophytes

roughened, thinning cartilage

mild, thickened inflamed synovium

thickened stretched capsule

Question 9

describe a joint with severe OA

Answer 9

Question 10

what is the onset like

Answer 10

gradual

Question 11

clinical features

Answer 11

mechanical pain

crepitus on movemenet

stiffness, inactivity gelling

bony swellings and deformity of joints

effusions and soft tissue swelling

Question 12

mechanical pain

Answer 12

worse with activity and at the end of the day

relieved by rest

Question 13

what can OA lead to

Answer 13

loss of function and mobility

joint deformity

Question 14

commonly affected joints

Answer 14

Question 15

what features are seen in the hands

Answer 15

Question 16

what are the 2 most common sites for OA

Answer 16

1. DIP
2. base of thumb

Question 17

what does OA in the base of the thumb lead to, and what particular movement makes pain worse

Answer 17

• subluxation of CMC joint
• worse on pinching movement
• thumb may ‘square’

Question 18

what may there be on the hands with associated OA

Answer 18

dorsal ganglion cyst may be present

Question 19

what is seen whe OA affects the knee

Answer 19

genu varum or valgum can predispose

osteophytes, effusions, crepitus and restriction of movement

bakers cyst

Question 20

genu varum and valgum

Answer 20

due to abnormalitites in the medial and lateral menisci respectively.

varum - medial OA

valgus - lateral OA

Question 21

bakers cyst

Answer 21

fluid filled swelling in popliteal fossa

also seen in RA

Question 22

effects of OA in the hip

Answer 22

restriction of movement

pain may be felt in groin or radiate to knee

Question 23

where may pain felt in the hip e from

Answer 23

lower back

Question 24

OA in the spine

Answer 24

osteophytes can impinge on nerve root causing weakness and pins and needles

pain and restriction

spinal stenosis

Question 25

diagnosis

Answer 25

history and examination are key bloods - inflammatory markers usually normal x ray

Question 26

x ray features

Answer 26

loss of joint space osteophytes sclerosis subchondral cysts

Question 27

what treatment is available for elbow OA

Answer 27

* elbow replacement * However, these are not good for young/active people and are limited to 5kg or 1kg repeatedly.

Question 28

non pharmacological management

Answer 28

* Education * Physiotherapy * Weight loss * Footwear * Aids e.g. walking stick

Question 29

first line analgesia

Answer 29

paracetamol and topical NSAIDs (for knees and hands)

Question 30

2nd line analgesia

Answer 30

* oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids (short term relief)

Question 31

what is NICE views on the use of viscosupplementation, hyaluronic acid injection, glucosamine or chondroitin.

Answer 31

they do not support it

Question 32

surgical management

Answer 32

fusion, replacement or total excision

Question 33

what surgery is available for varus knee

Answer 33

* osteotomy for isoated early medial OA compartment * However, this has lower satisfaction rates than TKR, variable duration of effect, and can affect results of later TKR * Is good in heavy manual workers. The results for valgus knee are less well established.