Osteoarthritis

Question 1

What is the most common arthritis and the leading cause of pain and disability worldwide?

Answer 1

• OA

Question 2

What is OA?

Answer 2

• progressive loss of articular cartilage
• remodelling of the underlying bone
• associated inflammation

Question 3

What joints are commonly affected in OA?

Answer 3

• knees
• hips
• small joints of hands

Question 4

What is the pathogenesis of OA?

Answer 4

1. degradation of cartilage & remodelling of bone due to active response of chondrocytes and inflammatory cells
2. Release of enzymes breakdown collagen and proteoglycans > destroy articular cartilage
3. Exposure of subchondral bone > sclerosis
4. Reactive remodelling > osteophyte formation & bone cyst
5. Joint space progressively lost over time

Question 5

What are the RF for OA?

Answer 5

• hereditary
• ageing
• female
• obesity
• high bone density - RF for development of OA
• low bone density - RF for progression of OA
• joint injury
• reduced muscle strength

Question 6

How would you clinically diagnose OA?

Answer 6

• Is aged 45 years or over; and
• Has activity-related joint pain; and
• Has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes.

Question 7

What are the sx for OA?

Answer 7

• Joint pain that is exacerbated by exercise and relieved by rest.
• Joint stiffness in the morning or after rest.
• Reduced function and participation restriction

Question 8

What are the signs of OA?

Answer 8

• Reduced range of joint movement.
• Pain on movement of the joint
• Joint swelling/synovitis (warmth, effusion, synovial thickening).
• Periarticular tenderness.
• Crepitus.
• Absence of systemic features such as fever or rash.
• Heberden’s nodes or Bouchard’s nodes
• Joint instability
• muscle weakness around joint

Question 10

What are the differentials for OA?

Answer 10

• knee
  
  • prepatellar bursitis
  • referred hip pain
  • meniscal/ligament tear
  • chondromalacia patellae
• hip
  
  • trochanteric bursitis
  • referred pain from knee
  • radiculopathy
  • iliotibial band syndrome
• hand
  
  • de quervain’s tenosynovitis
  • RA
  • gout

Question 11

What Ix would you perform for OA?

Answer 11

• xray of joint (LOSS)
• BMI

exclude other causes

• Blood test
• Joint aspiration
• MRI

Question 12

How would you mx OA?

Answer 12

Conservative

• Exercise
• Weight loss
• Thermotherapy
• Appropriate footwear advice
• bracing, assistive device
• Transcutaneous Electrical Nerve Stimulation (TENS)

Medication

• Paracetamol + NSAID
• Intra-articular corticosteroid injection

Surgery

• osteotomy
• arthrodesis
• arthroplasty

Question 13

How to prevent OA?

Answer 13

• Weight control.
• Increasing physical activity.
• Avoiding injury.
• Improving education about OA
• Optimal management of symptoms by GPs