Osteoarthritis

Question 1

What is osteoarthritis?

Answer 1

1. Asymmetrical degenerative synovial joint disease

2. Cartilage destruction exceeds repair, causing pain & instability

Question 2

What is common epid of osteoarthritis?

Answer 2

Women

50-70

Question 3

What are RF for osteoarthritis?

Answer 3

1. Female
2. Over 50
3. FHx of OA
4. Demanding sport or occupation
5. Obesity

Question 4

What are the most common joints affected in OA?

Answer 4

1. knee
2. hip
3. hands
4. lumbar
5. cervical spine

Question 5

What are classic symptoms of OA?

Answer 5

1. Joint pain
2. Morning stiffness: around 15 ins
3. Stiffness worse with activity
4. Limited range of motion
5. Bony deformities

Question 6

What are possible DDx for OA?

Answer 6

1. Bursitits
2. Gout
3. Pseudogout
4. RA
5. Psoriatic arthritis

Question 7

What investigations are used for OA?

Answer 7

1. X ray
2. CRP: normal
3. ESR: normal

Question 8

What is seen on x ray for osteoarthritis?

Answer 8

1. Loss of joint space
2. Osteophytes
3. Subarticular sclerosis
4. . Subchondral cysts

Question 9

What is management for osteoarthritis?

Answer 9

1. Topical analgesia e.g. capsaicin topical
2. Intra-articular corticosteroid injection
3. Paracetamol
4. NSAIDs
5. Opiod
6. Surgery (joint replacement)
   - Exercise and weight loss

Question 10

What are possible complications for OA?

Answer 10

1. Functional decline and inability to perform activities of daily living
2. Spinal stenosis in cervical and lumbar OA
3. NSAID-related GI bleeding
4. Effusion
5. NSAID related renal dysfunction

Question 11

What is primary osteoarthritis?

Answer 11

Localised (hands, knee, hip or foot) or generalised (hands and another joint)

Question 12

What is the cause of primary osteoarthirtis?

Answer 12

wear and tear of normal joint

Question 13

What is the usual epid of primary osteoarthritis?

Answer 13

1. Female
2. Obese
3. Older
4. Post menopausal
5. Occupation: gardener, hairdresser

Question 14

What is the usual causes of secondary osteoarthritis?

Answer 14

1. Inflammatory: RH or Septic arthritis
2. Congenital: DDH
3. Metabolic/Endo – wilson’s or acromegaly, haemchromatosis
4. Trauma

Question 15

What is the cause of

secondary osteoarthritis?

Answer 15

altered joint architecture/stability acquires further damage

Question 16

Why does osteoarthritis occur?

Answer 16

imbalance of cartilage matrix synthesis & degradation (increased catabolism or reduced formation)

Question 17

What is seen on joint aspiration for osetoarthritis?

Answer 17

: straw-coloured aspirate and high viscosity

Question 18

What are NICE reccomendations for osteoarthritis>

Answer 18

Patient >45 with no (or less than 30 mins) morning stiffness and ‘typical activity related joint pain’ does not need Ix but XR can confirm diagnosis & show severity. (NICE 2014)

Question 19

What are osteophytes?

Answer 19

spurs of bone projecting from either end of joint

Question 20

What is Subarticular/subchondral sclerosis?

Answer 20

increased bone density along joint line (where bones are in contact)

Question 21

What are subchondral cysts?

Answer 21

small, fluid-filled ‘holes’ in bone, along joint line

Question 22

What bony deformities are formed in osteoarthritis?

Answer 22

Nodes are formed by bony projection/enlargement (exostosis)

1. Herberden’s
2. Bouchard’s

Question 23

What are Herberden’s and Bouchard’s deformties?

Answer 23

• Heberden’s = bony swelling of the DIP joint

* Bouchard’s = same but at PIP

Question 24

What may you find O/E for osteoarthritis?

Answer 24

1. Creptius
2. Effusion, erythema
3. Squaring (base of thumb)
4. H and B