Clinical Medicine I: Osteoarthritis Diagnosis and Management

What is osteoarthritis (OA)?

A progressive, irreversible condition involving loss of articular cartilage that leads to pain and sometimes deformity.

Which joints are primarily affected by osteoarthritis?

Weight-bearing joints of the lower extremity and spine.

What are the two types of osteoarthritis?

Primary osteoarthritis and secondary osteoarthritis.

What are common risk factors for developing osteoarthritis?

Age, female gender (especially post-menopausal), genetics, obesity, previous joint trauma, osteopenia/osteoporosis, smoking, vitamin D deficiency, and certain occupations.

What distinguishes osteoarthritis from rheumatoid arthritis (RA)?

OA typically has minimal to no inflammation, while RA is characterized by significant inflammation.

What is a common symptom of osteoarthritis?

Pain with activity that improves with rest.

What is the typical duration of morning stiffness in osteoarthritis?

Usually lasts less than 30 minutes.

What physical exam findings are associated with osteoarthritis?

Tender joints, possible bone spurs (osteophytes), joint effusion, decreased range of motion, and crepitus.

What are Heberden and Bouchard nodes?

Enlargements of the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints commonly seen in hand osteoarthritis.

What is a Baker's cyst?

A fluid-filled cavity that communicates with the knee joint, commonly associated with knee effusion.

What are hallmark radiographic findings in osteoarthritis?

Loss of joint space, sclerosis, subchondral cysts, and osteophytes at the joint margin.

What laboratory findings are typically seen in osteoarthritis?

Erythrocyte sedimentation rate (ESR) is normal, rheumatoid factor is negative, and synovial fluid is non-inflammatory.

What is the Kellgren-Lawrence grading scale used for?

To grade the severity of osteoarthritis based on radiographic findings.

What is the recommended weight loss for reducing the risk of osteoarthritis?

A 10-pound weight loss over 10 years may decrease the risk for OA development by 50%.

What types of exercises are beneficial for osteoarthritis patients?

Water aerobics, elliptical machine, cycling, and tai chi.

What are common pharmacologic treatments for osteoarthritis?

NSAIDs are the mainstay of treatment; topical NSAIDs are often tried first.

What is the role of glucocorticoids in osteoarthritis treatment?

They provide short-term relief of symptoms but can have long-term harms to cartilage.

What is visco-supplementation?

Injection of hyaluronic acid into the joint space to lubricate the joint and lessen OA pain.

What is the indication for considering joint arthroplasty?

If conservative treatments fail and there is severe loss of joint function.

What are the common symptoms of osteoarthritis in the hip?

Deep groin pain that may radiate to the lower femur or upper knee, with limited internal rotation.

What is the significance of crepitus in osteoarthritis?

It is a common finding during active and passive range of motion (AROM and PROM).

How does osteoarthritis typically present in the knee?

With genu varum or genu valgum, crepitus, and possibly a Baker's cyst.

What is the typical pain description in osteoarthritis?

Deep, poorly localized, and aching pain that is exacerbated by activity.

What is the expected response of osteoarthritis pain to weather changes?

Patients may report changes in pain with weather changes.

What is the role of complementary and alternative medicine (CAM) in osteoarthritis?

Includes treatments like acupuncture, chiropractic care, and nutritional supplements.

What is the recommended approach for patients with increased risk of NSAID-induced GI toxicity?

Consider adding a proton pump inhibitor (PPI) or using COX-2 inhibitors.

What is the current recommendation regarding acetaminophen for osteoarthritis?

Acetaminophen is no longer recommended as a first-line treatment.