Osteoarthritis

Case osteoarthritis

Osteoarthritis

History

· Age.

· Pain in the joints.

· Stiffness after a period of inactivity.

· Impairment of gait due to joint pain.

OA most commonly affects the weight-bearing joints, in particular the knees, hips and spine, and the interphalangeal joints of the hands (3.64). The wrists, shoulders and ankles are less

often involved.

Pain can be severe and incapacitating and

is worse on use of the joint and at the end of the day.

Morning stiffness is not common, though stiffness after prolonged inactivity may occur.

Clinical signs in advanced cases include

crepitus, limitation of movement and joint deformities. The

Osteophytosis (formation of new bone), altered bone contour, subchondral sclerosis (increased bone density) and cystic formation result from bony remodelling. T

Examination

· Heberden's nodes (bony swellings) at the terminal interphalangeal joints.

· Squaring of the hands due to subluxation of the first metacarpophalangeal joint.

Proceed as follows:

Tell the .examiner that you would like to examine the hips and knees as these joints are usually involved

·        feel the knee for crepitus:

it may be red, warm and tender, and have an effusion).

QUESTIONS

Which other joints are frequently involved?

·        Spine, in particular cervical and lumbar spines.

Mention the types and a few causes of osteoarthrosis?

· Primary.

· Secondary:

-Trauma - affects athletes, pneumatic drill workers, anyone doing work involving heavy lifting.

- Inflammatory arthropathies - rheumatoid arthritis, septic arthritis, gout.

- Neuropathic joints - in diabetes mellitus, syringomyelia, tabes dorsalis.

-Endocrine - acromegaly, hyperparathyroidism.

-Metabolic chondrocalcinosis, haemochromatosis.

What are Heberden's nodes?

Bony swellings seen at the terminal interphalangeal joints in osteoarthrosis.

What are Bouchard's nodes?

Bony swellings at the proximal interphalangeal joints in osteoarthrosis.

ADVANCED-LEVEL QUESTIONS

What are the typical radiological features?

· Subchondral bone sclerosis and cysts.

· Osteophytes.

What will the synovial aspirate show?

Fewer than 100 white blood cells per millilitre.

How would you manage a patient with osteoarthrosis?

· Change in lifestyle: maintain optimal weight, encourage exercise, use appropriate footwear.

· Drugs: simple analgesics, rubifacients, NSAIDs for acute flare-ups, intra-articular corticosteroid injections for acute flare-ups or

patients unfit for surgery.

· Surgery: arthroscopic removal of loose body, arthroscopic washout or radio-isotope synovectomy for persistent synovitis, joint

replacement for hip and knee.

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