Osteoarthritis and Principles of Management Flashcards
Who manages osteoarthritis?
Physicians, nurses, GPs, patients, dieticians, occupational therapists, physiotherapists and orthopaedic surgeons
What is osteoarthritis?
Degeneration of joints due to breakdown of articular cartilage and bone joint
Trauma and mechanical imbalance
Inflammation and pain
Repair processes around the joint
What are the biomechanical factors of osteoarthritis?
Abnormal anatomy (DDH), intra-articular fracture, ligament rupture, meniscal injury and occupation - farmers and footballers
Persistent heavy physical activity, elite running and obesity
What is inflammation in osteoarthritis caused by?
Synovial hypertrophy, subchondral changes and joint effusion
What are possible biochemical mediators for osteoarthritis?
IL-1beta, TNF-alpha, and MMPs
Describe the pathogenesis of osteoarthritis
Muscle weakness, ligament injury and abnormal anatomy leads to instability/ malalignment
Increased load - joint microtrauma - synovitis and osteoarthritic joint
What is the clinical diagnosis for osteoarthritis?
45 year plus
Activity related joint pain plus has no morning joint related stiffness or morning stiffness that lasts no longer than 30 mins
What are important symptoms to look out for?
Trauma, prolonged morning related stiffness, rapid deterioration of symptoms and hot, swollen joint
What are the differential diagnosis for osteoarthritis?
Gout, other inflammatory arthritis, septic arthritis and malignancy
What is the NICE guidelines for management of osteoarthritis?
Holistic approach and self management - exercise and weight loss - additional options include surgery, non-pharmacological and pharmacological options
What are the holistic factors in a person with osteoarthritis?
Social, health benefits, occupational, mood, quality of sleep, support network, MSK pain, attitudes, influence of comorbidity and pain assessment
What are some non-pharmacological treatments for osteoarthritis?
Thermotherapy, electrotherapy, aids + devices, and manual therapy (massages, physio…)
What are pharmacological treatments for osteoarthritis?
Oral analgesia - paracetamol and NSAIDs
Topical - NSAIDs and capsaicin
Intra-articular injections - steroids and hyaluronic acid
When does a person with osteoarthritis need referred for surgery?
Substantial impact on QoL
Refractory to non-surgical treatment
Referral letter
When options exhausted and QoL is suffering
