Osteoarthritis and MKS

How does NICE define OA

• clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life

What is OA characterised by

• localised loss of articular cartilage, remodelling of adjacent bone, and associated inflammation

• occasionally bone hypertrophy

Risk factors of OA

• Hereditary factors

• Occupational factors e.g., frequent kneeling/squatting

• Obesity - with an increasing BMI linked to a worsening of hand/knee OA bc increased load

• Joint injury - constant stressors in athletic individuals bc instability or misalignment; muscle weakness

What causes the symptoms of OA

• loss of spongy cartilage → covers ends of bones meet at joint providing shock absorption and slip so bone moves w/ little friction

Where is inflammation found in osteoarthritis

• ligaments and subchondral bone (the bone beneath the cartilage)

• linked to level of impairment and disease progression in OA

What is the hypertrophic response in osteoarthritis

• some joints: bone shows an increased growth response, forming bony spurs

• does not relate to extent of pain or OA progression

How does OA progress

• disease process starts long before symptoms = apparent

• some develop joint pain and stiffness when little cartilage degenerated

• some have no symptoms

What happens to cartilage in untreated osteoarthritis

• Cartilage continues to degenerate, and surrounding tissues experience inflammatory, hypertrophic, and biochemical changes

• creates unique symptoms for each patient

How does cartilage loss affect knee osteoarthritis symptoms

• less cartilage remaining, the more severe the symptoms

• as OA worsens knee may swell constantly, muscles weaken and walking = painful often needing cane

What are common clinical symptoms of knee osteoarthritis

• Increasing discomfort with walking

• pain on stair climbing

• stiffness after sitting

• swelling after activity.

What factors can lead to hip osteoarthritis at an earlier age

• Congenital hip dysplasia and abnormal hip structures can lead to OA symptoms around age 40

How does weight-bearing activity affect hip osteoarthritis

• accelerate cartilage deterioration

• causing walking pain

• potentially require hip replacement

How does osteoarthritis commonly affect the hands

• Particularly in women around 50

• extra bone forms around the knuckles

• causing stiffness and swelling in a "nodal" pattern

• can also occur in wrist-thumb joint → impair activities like writing and typing (require pain management or maybe surgery)

Where in the foot is osteoarthritis most commonly found and management

• big toe joint

• manageable with support and painkillers

• occasionally need surgery if severe

• rare to be in ankle unless history of injury → causes pain when walking and severe cases may require fusion surgery

What typically causes osteoarthritis in the shoulder and treatment

• usually prior injuries

• NSAIDs are common treatments,

• surgery last resort to relieve pain → may limit motion

How can osteoarthritis affect the spine and treatment

• affects the cartilage between vertebrae

• often with intermittent back pain starting in early 40s

• worsened by heavy activity

• Pain medication, gentle exercise, steroid injections, and in severe cases, surgery to clear overgrown bone if nerves are impacted

Common symptoms for OA

• Stiffness

• fatigue

• weakness

• joint pain

• sometimes swelling and deformity

What signs might a healthcare provider check for in osteoarthritis

• Discomfort on movement

• limited range of motion

• swelling

• warmth

• tenderness

• abnormal gait

• crepitation (joint cracking or crunching

Education and self management for Pts w/ OA

• Patients with OA should exercise as a core treatment irrespective of age, comorbidities, pain severity or disability → include both local muscle strengthening and general aerobic fitness

• Weight loss if obese/overweight

• Health professionals should offer appropriate advice on footwear for those with lower limb OA.

Pharmacological management of OA

• Offer a topical non-steroidal anti-inflammatory (NSAID) drug to patients with OA for any joint.

• If a topical NSAID is ineffective or unsuitable, consider using an oral NSAID but consider the potential for gastrointestinal, renal, liver and cardiovascular toxicity

• Provide gastroprotective agents such as a proton pump inhibitor if using an oral NSAID

• Do not routinely offer paracetamol or a weak opioid unless infrequent, short-term use or where other treatments are contra-indicated, not tolerated or ineffective

• If patients wish to use glucosamine or strong opioids → limited evidence to support, risks outweigh benefits