Transcript Osteoarthritis

Nichola Caiger, F1
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To refresh your knowledge of:
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S/S of OA
Risk factors for OA
Investigations
Management of OA
Complications of OA
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Mr S is a 78 y/o man, c/o knee pain
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Rheumatoid
arthritis
Osteoarthritis
Gout
Psuedogout
Septic arthritis
Haemarthrosis
Benign/malignant
tumour
Referred pain
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Muscle strain
Bakers cyst
Bursitis
Fracture
Torn ligament
Meniscal tear
Tendonitis
Etc.
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Minimal morning stiffness
Pain worse on movement
Pain worse at the end of the day
Pain relieved by rest
Often affects weight bearing joints
Reduced ROM
Joint may ‘lock’ or ‘give way’
Joint swelling and tenderness
Joints feel like they are ‘grating’ or ‘cracking’
Weakness and muscle wasting
Unilateral at onset (often bilateral with time)
Stiffness after rest
Rest pain when severe
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PMH
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FH
◦ Tibial plateau # as a
teen
◦ Previous
meniscectomy
◦ Dad had bilateral hip
replacements
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DH
◦ Paracetamol & topical
ibuprofen for pain
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SH
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ICE
◦ Retired
◦ Walks with a stick
◦ Lives in a residential
home
◦ Non-smoker, teetotal
◦ Worried he won’t be
able to walk any
more
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Reduced ROM
Pain on movement
Joint swelling
Joint tenderness
Crepitus
Absence of systemic features suggestive of RA
Deformity
Bouchard’s/Heberden’s nodes
Joint instability
Muscle weakness/wasting
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Often a clinical diagnosis
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Bedside
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Bloods
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Imaging
◦ BMI should be recorded
◦ Usually NAD in OA
◦ May be performed to assess joint damage or R/O differentials
 Degree of damage seen does not necessarily correlate with symptom severity
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Special tests
◦ Joint aspiration – R/O differentials
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Conservative
◦ Screen for low mood
◦ Promote activity and healthy diet +/- physio
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 Strengthens the muscles around the joint, providing
extra support
 Promotes weight loss
 May reduce joint pain and improve joint function
Patient education
Walking aids and assistive devices
Hot or cold packs (thermotherapy)
Electrotherapy using TENS (transcutaneous
electrical nerve stimulation)
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Medical
◦ Analgesia
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Paracetamol and topical NSAIDs first line
Capsaicin cream
Oral NSAIDs and selective COX2 inhibitors
Intra-articular injections – corticosteroid + LA
Surgical
◦ Surgery
 E.g. arthroplasty, arthrodesis, osteotomy
 NB: arthroscopy usually avoided unless clear
symptoms of mechanical locking
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Reduced mobility and chronic pain
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Loss of independence
Effects on employment, social life, hobbies etc.
Risk of low mood
May affect quality of sleep
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Holistic approach to the patient
◦ Biopsychosocial
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In finals you are expected to act like a safe
F1, you do not have to know all of the
answers!
Use the ABCDE approach with all acutely
unwell patients
Have a system and practice using it
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http://www.patient.co.uk/doctor/osteoarthrit
is-pro
http://www.nhs.uk/conditions/Osteoarthritis
/Pages/Introduction.aspx
http://www.nice.org.uk/guidance/CG177
http://pathways.nice.org.uk/pathways/osteo
arthritis
Oxford Handbook of Clinical Medicine