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  1. Osteoarthritis Definition
    • A degenerative disease of articular
    • cartilage associated with secondary changes in underlying bone resulting in pain and impaired function of the affected joint.

    The main effects on the erosion of cartilage are independent of acute or chronic inflammation, even though  inflammatory cells may be present in the affected joint.
  2. OA Prevalence, Onset, Which joints
    • Prevalence: 80% of elderly population have evidence of OA, but only 25% are symptomatic
    • Onset: any age, but increases a lot over 60 years
    • Joinst: those exposed to constant wear and teaer e.g. large weight bearing joints (knee/hip) and small joints of the hands (base of thumb, DIPs)
  3. Aetiology - primary and secondary
    • Primary: no obvious cause or
    • predisposing factors (most cases)

    • Secondary: from a complication of
    • other joint disorders, mainly inflammatory joint disease, congenital joint
    • deformities, trauma to joints, avascular necrosis of bone, occupational joint
    • disease (e.g. OA in fingers of a typist)
  4. Modifiavle Risk Factors
    • Abnormal load on joints
    • Repetitive loading
    • Trauma
  5. Unmodifiable Risk Factors
    • Ageing
    • Genetic predisposition
    • Female gender (except hip OA)
    • Abnormal joint structure
  6. Pathological Changes in early OA
    • Erosion and destruction of articular cartilage --> degenerate superficial cartilage splits along lines of fibres to produce fronds (fibrillation), leading to a narrowing of the joint space
    • Inflammation and thickening of joint capsule and synovium
  7. Pathological Changes in Late OA
    • LOSS plus reactive thickening of synovium and joint capsule and disuse atrophy of muscle
    • Sclerosis of subarticular bone – due to
    • constant friction of naked bone surfaces which now articulate in the absence of
    • cartilage (bone eburnation)

    • ·      
    • Osteophytes: form around the periphery of
    • the joint by irregular outgrowth of the bone. Some may break off to form loose
    • bodies within the joint.
    • Subchondral cysts: small cysts in areas where
    • the bone is not thickened as a result of synovial fluid accumulation in underlying bone   
    • Reactive thickening of synovium and joint capsule caused by bone and cartilage debris
    • Disuse atrophy of muscle due to immobility of the diseased joint
  8. Heberden's and Bouchard's nodes
    • Heberden’s nodes: small nodules in the DIPjoints caused by osteophytes. Bouchard’s nodes: small nodules in the PIPjoints caused by osteophytes
    • Bouchard's nodes: small nodules in the PIP joints caused by osteophytes
  9. OA Clinical Features
    • Pain
    • Limited ROM of affected joint (often leading to functional impairment)
    • Visible swelling around joint margins (sometimes, usually due to osteophytes)
    • OA cervical verebra (cervical spondylosis): osteophytes compress emerging spinal nerves
  10. OA Radiological Features
    • Loss of joint space
    • Osteophytes
    • Subchondral sclerosis
    • Subchondral cysts
  11. Treatment (3 ways)
    • Lifestyle: reduced pressure across joint (e.g. weight loss, walking stick) and encourage strengthening exercises
    • Medical: Analgesics and NSAIDs; intra-articular or periarticular corticosteroid infections if severe pain
    • Surgical:joint replacement for advanced hip or knee disease
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NRO MCQ flashcards
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