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Osteoarthritis (OA)

Osteoarthritis (OA) is due to wear and tear of the joints over time. It's due to Overuse, injury, and genetics (not inflammation as in RA). Risk factors include:

  • Obesity

  • Age

  • Female

  • Family hx

  • Occupation - overuse of certain joints

  • Trauma


Presentation

  • Joint pain and stiffness

    • Worse with movement, better with rest

    • Typically affects the weight-bearing joints e.g. Hip, Knee

  • Non-prolonged morning stiffness (< 20 mins)


O/E - Bouchard’s nodes (PIP), Heberden’s nodes (DIP), Squaring of thumb base

“Osteoarthritis” © Laboratoires Servier CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Investigations

Diagnosed clinically in those > 45 years presenting with typical symptoms of joint pain + stiffness, worsened by activity w/o prolonged morning stiffness (< 20 mins).


Knee XR - Will show LOSS:

  • Loss of joint space

  • Osteophytes

  • Subarticular sclerosis - increased bone density along joint line

  • Subchondral cysts - fluid-filled holes in bone

“Severe osteoarthritis and osteopenia of the carpal joint and 1st carpometacarpal joint” © James Heilman, MD CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

Management

Conservative/lifestyle - Weight loss, Physiotherapy, Aerobic exercises (e.g. swimming)


Medical options:

  • Topical NSAIDs - pain ladder is used here

  • Intra-articular steroid injections - effective, but temporary pain relief


Surgical option - Joint replacement (Arthroplasty) - Excellent pain relief, but won’t improve function. It's considered in the more severe cases after exhausting other options.




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