Osteoarthritis and Principles of Management

Question 1

commonest form of joint problem

Answer 1

osteoarthritis

Question 2

How do you define

Answer 2

“Tear, flare and repair”

tear -microdamage to cartilage of joint

flare - inflammatory response

repair- continually over time

Question 3

Osteoarthritis - pathogenesis

Answer 3

• repetitive microdamage - Trauma & mechanical imbalance
• Inflammation & pain
• Repair processes around the joint

Question 4

Biomechanical Factors (5)

Answer 4

• Abnormal anatomy (DDH) increased load, articular cartilage fails
• Intra-articular fracture - more acute - rapid degradation of articular cartilage
• Ligament rupture - damage to cushion - continual micro trauma
• Meniscal injury - remove meniscus - biomechanical forces
• Occupation – farmers, - football players, obesity, elite running

Question 5

Inflammation in osteoarthritis (3)

Answer 5

• Synovial hypertrophy
• Subchondral changes - bone thickens
• Joint effusion

Question 6

Biochemical Mediators in osteoarthritis are? (3)

Answer 6

IL-1𝝱, TNF 𝜶, MMPs…

Question 7

Pathogenesis of OA

Answer 7

muscle weakness, ligament injury, abnormal anatomy

• instability
• increased load
• joint microtrauma
• OA, synovitis

Question 8

How do we diagnose

Answer 8

clinical grounds
over 45 years old
- Activity-related joint PAIN plus
has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes

Question 9

Be aware of… in OA ?

Answer 9

Trauma
Prolonged morning-related stiffness
Rapid deterioration of symptoms
Hot, swollen joint

Question 10

Differential diagnosis (4)

Answer 10

Gout
Other inflammatory arthritides (RA)
Septic arthritis - Sudden onset, swollen painful joints
Malignancy

Question 11

Investigations of OA

Answer 11

X-RAY - LITTLE CHANGES early on

MRI

Question 12

Holistic approach covers? (6)

Answer 12

social affect
lifestyle expectations 
mood
occupation
support network
patient knowledge - ice

Question 13

Non-pharmacological treatments (4)

what do NICE not recommend?

Answer 13

• Thermotherapy
• Electrotherapy
• Aids and devices - splint - base of thumb
• Manual therapy - physio, massage

NICE do not recommend: acupuncture, nutraceuticals (glucosamine, chondroitin)

Question 14

Pharmacological treatments (3)

Answer 14

• Oral analgesia: paracetamol, NSAIDs
• Topical treatments: NSAIDs, capsaicin (knee, hand)
• Intra-Articular injections - - steroid (hyaluronic acid)

chronic pain ladder can move up to opiates, try to resit in OA

Question 15

When to refer to surgery? (3)

Answer 15

• Substantial impact on quality of life
• Refractory to non-surgical treatment
• Referral letter

Question 16

treatment for advanced OA?

Answer 16

Joint replacement surgery

Question 17

OA is a significant cause of?

Answer 17

morbidity