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Flashcards in Osteoarthritis Deck (9)
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1

What is osteoarthritis?

Often described as a wear and tear in the joints. It is thought to be the result of an imbalance between the cartilage being worn down and the chondrocytes repairing it, leading to structural issues in the joint.

It is not an inflammatory condition like rheumatoid arthritis.

It occurs in the synovial joints and is a result of a combination of genetic factor, overuse and injury.

2

What are the risk factors of osteoarthritis?

Obesity
Age
Occupation
Trauma
Female
Family history

3

What changes are seen on Xray with osteoarthritis?

Four key changes (LOSS):
1) L - Loss of joint space

2) O - Osteophytes

3) S - Subarticular sclerosis (Increased density of the bone along the joint)

4) S - Subchondral cysts (Fluid filled holes in the bone)

It should be noted that the changes on Xray do not correlate with symptoms.

4

How would someone commonly present with osteoarthritis?

Joint pain and stiffness that tends to be worsened by activity in contrast to inflammatory arthritis where activity improves symptoms.

Also:
Deformity
Instability
Reduced function of joint

5

Which joints are commonly affected within osteoarthritis?

> Hips
> Knees
> Sacro-iliac joints
> Distal-interphalangeal joint in the hands (DIPs)
> The MCP joint at the base of the thumb
> Wrist
> Cervical spine

6

Signs of osteoarthritis within the hands?

1) Herberdens nodes (DIP)

2) Bouchards nodes (PIP)

3) Squaring at the base of the thumb at the carbo-metacarpal joint

4) Weak grip

5) Reduced range of motion

7

Which bone in the hand is the base of the thumb?

The trapezius bone which the metacarpal bone of the thumb sits on.

It gets used a lot from everyday activity which makes it very prone to water when used fro complex movements.

8

How is osteoarthritis diagnosed?

It is said that if over 45 a diagnosis can be made on the basis of typical activity related pain and has no morning stiffness or stiffness lasting less than 30 minutes.

In younger individuals Xray for LOSS:
L - Loss of joint space
O - Osteophytes
S - Subarticular sclerosis
S - Subchondral cysts

9

How is osteoarthritis managed?

> Patient education about the condition

> Lifestyle changes:
- Weight loss if overweight to reduce the load on the joint
- Physiotherapy to improve strength to support the joint
- Occupational therapy and orthotics to support activities and function

> Stepwise use of analgesia to control symptoms:
1) Oral paracetamol and topical NSAIDs or topical capsaicin (chilli pepper extract)
2) Add oral NSAIDs and consider also prescribing a proton pump inhibitor (PPI) to protect their stomach such as omeprazole
3) Consider opiates such as codeine and morphine.

> Intra-articular steroid injections provide a temporary reduction in inflammation and improve symptoms

> Joint replacement can used in severe cases. The hip and knee are the most commonly replaced joints