Osteoarthritis and Principles of Management Flashcards
What is the commonest form of joint problem?
Osteoarthritis
Describe the pathogenesis of osteoarthritis?
- Trauma and mechanical imbalance
- Inflammation and pain
- Repair processes around joint
What are risk factors for biomechanical fractures?
- Abnormal anatomy
- Intra-articular fracture
- Ligament rupture
- Meniscal injury
- Occupation
- Farmers, football players
- Persistent heavy physical activity
- Obesity
What inflammation occurs in osteoarthritis?
- Synovial hypertrophy
- Subchondral changes
- Joint effusion
How is osteoarthritis diagnosed?
- Made on clinical grounds
- 45+ years in general
- Activity related joint pain plus
- Either no morning joint related stiffness or morning stiffness that lasts no longer than 30 minutes
Describe the typical presentation of osteoarthritis?
- Activity related joint pain plus
- Either no morning joint related stiffness or morning stiffness that lasts no longer than 30 minutes
What are some clinical features not common in osteoarthritis and suggestive of other inflammatory process?
- Prolonged morning stiffness
- Rapid deterioration of symptoms
- Hot, swollen joint
What is the differential diagnosis of osteoarthritis?
- Gout
- Other inflammatory arthritides
- Septic arthritis
- Malignancy
What investigation should be done for osteoarthritis to confirm diagnosis?
- X-ray to confirm clinical diagnosis
- No x-ray changes in early stages, only on MRI
Where are most patients with osteoarthritis managemed?
Most patients managed in community by MDT
What is the treatment for osteoarthritis?
- Self management in early stages
- Weight loss and exercise
- Occupation
- Effect on social life
- Pain assessment
- Additional treatment options are non-pharmacology, pharmacological and surgical
- Non-pharmacological
- Thermotherapy
- Electrotherapy
- Aids and devices
- Manual therapy
- Pharmacological
- Oral analgesia
- Paracetomol, NSAIDs
- Topical treatment
- NSAIDs, capsaicin
- Intra-articular injections
- Steroids (hyaluronic acid)
- Oral analgesia
- Surgery
- Refer when
- Substantial impact on QoL
- Refractory to non-surgical treatment
- Referral letter
- Joint replacement surgery is treatment for advanced osteoarthritis (OA)
- Refer when
What are some non-pharmacological therpies for osteoarthritis?
- Thermotherapy
- Electrotherapy
- Aids and devices
- Manual therapy
NOT ACUPUNCTURE
What are some pharmacological therpies for osteoarthritis?
- Oral analgesia
- Paracetomol, NSAIDs
- Topical treatment
- NSAIDs, capsaicin
- Intra-articular injections
- Steroids (hyaluronic acid)
When should patients with osteoarthritis be referred for surgery?
- Refer when
- Substantial impact on QoL
- Refractory to non-surgical treatment
What is the surgical treatment for osteoarthritis?
- Joint replacement surgery is treatment for advanced osteoarthritis (OA)
