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WEEK 32:
OSTEOARTHRITIS PLENARY:
| Question | Answer |
|---|---|
| OA | disorder of synovial joints triggering repair processes leading to structural changes within a joint where repair alters structure of joint over time |
| questions to investigate someone with arthritis | pain/site/duration of joint affected (swelling redness or stiffness) function (does it stop them from doing anything) impact (biopsychosocial) how managing pain previous trauma social (occupation, high impact sports) examination (restricted movement |
| risk factors | increasing age (biggest risk factor) gender (hip OA 2x more common in women than men) obesity (knee OA 3x increased risk) mechanics strength history genetics (more common in MZ than DZ) |
| occupations associated with hip OA | farmers construction workers truck drivers/machinery operators police officers healthcare workers |
| occupations associated with knee OA | construction workers farmers and agricultural workers miners cleaners and janitors military personnel professional athletes warehouse workers/packers |
| impact of OA | joint deformity functional impairment and disability (hand grip, walking, climbing stairs etc) pain psychological impact (sleep quality, isolation, increasing dependency) falls |
| examination may show | bony swelling and joint deformity joint effusions (mainly knee), warmth, tenderness muscle wasting and weakness restricted painful movement of joint joint instability (locking or giving way) crepitus (grating or crunching sound by friction) |
| hand OA | commonly CMC, PIP and DIP thenar wasting squaring of thumb base herberden (PIP) and Bouchard (DIP) nodes JSN (joint space narrowing) |
| knee OA | often bilateral and symmetrical unilateral OA often secondary to predisposing trauma pain associated with site of OA in advanced disease (bone swelling, varus/valgus, deformity, antalgic gait) |
| antalgic gait meaning | limping walk caused by pain |
| varus deformity meaning | joint angled inward (knee outward o legs) |
| valgus deformity meaning | joint angled outward (knee inward x legs) |
| hip OA | pain in groin on walking and climbing stairs can be difficult sleeping and lying on affected side antalgic and trendelenburg gait (avoid putting weight through affected hip) |
| difference in blood tests in OA and RA | not done in OA as this does not directly affect biochemistry, haematology or immunology but should be used in RA |
| RA blood tests used | FBC CRP ESR UE LFT (liver function test) RF (rheumatoid factor) anti CCP (anti-cyclic citrullinated peptide antibody) |
| RF (rheumatoid factor) | autoantibody (antibody against own tissues) |
| when should xray be used | RA to show erosions and joint space narrowing |
| when should USS/MRI be used | synovitis |
| when do you xray | diagnostic uncertainty when considering possible referral for surgery |
| management of OA | education (explain nature of OA what contributes, weight loss) therapeutic exercise walking aids shock absorbing footwear |
| healthcare professionals involved | physio occupational therapist orthotics/ podiatry |
| pharmacological treatment | simple analgesia (topical NSAIDs regular use NO PARACETMOL) and if it doesnt work switch topical to oral eg ibuprofen, naproxen |
| issues with NSAIDs to warn patient about | bleeding bruising can also consider opioids eg codeine or topical capsaicin for hand/knee involvement |
| issues with opioids to warm patient about | SE eg constipation, drowsiness, nausea, dizziness etc |
| other drugs apart from NSAIDs and opioids to give | duloxetine |
| steroid injection examples | methylprednisolone, triamcinalone |
| benefits of injected steroids | pain relief and improvement in physical functioning by reducing inflammation |
| side effects of injected steroids | pain discomfort following injection bruising infection, redness, swelling fat necrosis, tendon rupture skin change (atrophy, pallor) increase in blood sugar levels and blood pressure |
| steroid injection regimen | usually 6 weeks between 1 injection and next (usually recommend no more than 3 injections in same joint space within 12 months) |
| who cant have steroid injection | those on anticoagulants (need to stop them) those awaiting joint surgery those waiting joint replacement |
| osteophytes | bony outgrowths forming along edges of joints where there is long term joint degeneration in OA |
| types of joint surgery | total or partial joint replacement arthroscopy and debridgement osteotomy cartilage replacement |
| potential benefits of joint replacement | freedom from pain improved mobility improved quality of life |
| potential risks of joint replacement | replacement wearing out not as good as natural knee as restricted movement numbness stiffness no guarantee will eliminate pain or restore function risks of infection, joint loosening, VTE effects of surgery and recovery period |
Created by:
kablooey
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