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A disease of synovial joints characterised by cartilage loss and accompanying periarticular change


Epidemiology of osteoarthritis (OA)

  • Very common:
    • >80% of over 65 years have radiographic signs of OA
  • Women>men, particularly hand and knee OA
  • Geographically, OA happens everywhere but is commoner in Caucasians


Pathophysiology of osteoarthritis (OA)

  • Inflammation occurs as cytokines and metalloproteinases are released into the joint
  • Initially hypertrophic repair of the cartilage, then flaking occurs
  • Over time loss of cartilage leads to loss of joint space


Risk factors for osteoarthritis (OA)

  • Increasing age
  • Female sex
  • Abnormal joint e.g. congenital hip dysplasia
  • External Joint stress
    • Obesity
    • Occupational stress on joint (pneumatic drills, athletes, etc.)
    • Trauma
  • Internal joint stress
    • Crystal deposition (gout and pseudogout)
    • Previous joint infection


Presentation of osteoarthritis (OA)

  • Joint pain exacerbated by exercise and relieved by rest
  • Joint stiffness after rest
  • Reduced range of movement
  • Joint swelling
  • Signs of synovitis: warmth, effusion
  • Tenderness around joint
  • Crepitus
  • Malalignment
  • Osteophyte formation
    • Heberden’s nodes: DIP joints
    • Bouchard’s nodes: PIP joints



Diagnosis and investigation of osteoarthritis (OA)

  • OA can be diagnosed without investigation in those over 45 with joint pain on exertion and an absence of stiffness
  • Body weight and BMI
  • Note this as a baseline – obesity is the simplest modifiable risk factor
  • If in doubt regarding diagnosis:
    • Bloods
      • ESR and CRP normal (raised in inflammatory arthropathies)
      • Rheumatoid factor
    • Joint aspiration and microscopy (excludes septic arthritis and crystal arthropathies)
    • Plain X-rays (normal until OA advanced, but will then show):
      • Osteophytes
      • Bone cysts
      • Joint space narrowing
      • Sub-articular sclerosis
    • MRI
      • More sensitive to early cartilage and subchondral bone changes than XR
    • Arthroscopy
      • Fissuring and early erosion of cartilage


Treatment of osteoarthritis (OA)

  • Conservative
    • Exercise:  aids weight loss and improves muscle mass and strength around the joint, both of which can improve symptoms
    • Adjust diet to lose weight
    • Physiotherapy
    • Heat/cold pads can help with pain
  • Pharmaceutical
    • Paracetamol (regularly)
    • Topical NSAIDs
    • Topical capsaicin
    • Oral NSAIDs
      • If NSAIDs used regularly add gastric protection
    • Consider intra-articular steroids e.g. in carpometacarpal joint or knee OA
  • Surgical
    • Arthroscopy and debridement
    • Joint replacement surgery often gives very good results, particularly in the hip and knee


Prognosis of OA

  • Most people with OA do not become severely disabled
  • Knee OA seems to have the worst prognosis in terms of deterioration over 10 years


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