Year 1 - BMF - Osteoarthritis_November 2024

Osteoarthritis Overview

  • Osteoarthritis (OA) is a chronic degenerative joint condition caused by:

    • Loss of cartilage in joint spaces.

    • Bone remodeling, osteophyte (bony spur) formation, and synovial inflammation.

  • Symptoms: Pain, stiffness, swelling, and reduced joint function.

  • Commonly Affected Joints: Knees, hips, hands, spine.

Page 8: Why OA Develops

  • Imbalance in tissue injury and repair:

    • Injury exceeds the ability to repair

  • Examples of contributing factors:

    • Abnormal loading of normal tissues (e.g., obesity)

    • Age-related decline in cartilage repair ability

Risk Factors

  1. Non-Modifiable:

    • Age: Risk increases with age.

    • Sex: Women are at higher risk (knee and hand OA).

    • Genetics: Family history or hereditary conditions like hemochromatosis.

    • Prior Conditions: Inflammatory arthritis (e.g., rheumatoid arthritis) or septic arthritis.

  2. Modifiable:

    • Obesity:

      • Strong link: BMI of 30-35 increases knee OA risk 4x.

      • Weight loss 5kg significantly reduces risk and symptoms.

    • Repetitive Use: Occupation or sports-related joint overuse.

    • Muscle Weakness: Reduced strength and bulk contribute to joint instability.

    • Trauma: Previous injuries increase susceptibility.

Page 13: Symptoms in Osteoarthritis

Symptoms:

  • Pain and Stiffness:

    • Worse with prolonged use and after inactivity.

    • Pain influenced by sleep, stress, and emotional factors.

  • Patterns:

    • Hands (e.g., Heberden’s and Bouchard’s nodes).

    • Large weight-bearing joints (knees, hips).

    • Generalized or localized (e.g., spine).

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Diagnosis

  • Clinical Diagnosis:

    • Based on history (pain, stiffness, affected joints) and physical examination.

  • Investigations:

    • Blood Tests: Normal; used to rule out other types of arthritis.

    • X-rays:

      • Abnormal in advanced disease.

      • Show joint space narrowing, osteophytes, and sclerosis (increased bone density showing white on x-ray).

Management

Goals:

  • Relieve pain.

  • Maintain or restore joint function.

  • Delay disease progression.

Prevention:

  • Maintain normal BMI.

  • Avoid joint overuse and minimize trauma.

Acute Management:

  • Pain Control:

    1. Paracetamol: First-line for mild symptoms.

    2. NSAIDs (e.g., ibuprofen, naproxen):

      • Provide better relief but may cause GI or renal side effects.

    3. Mild Opioids (e.g., codeine): For severe cases.

    4. Corticosteroid Injections:

      • Intra-articular for short-term relief and improved mobility.

Chronic Management:

  1. Lifestyle:

    • Weight Loss:

      • Reduces symptoms and slows progression (target: >5% weight loss).

    • Exercise:

      • Aerobic and low-impact exercises improve function and mobility.

      • Compliance is key for long-term benefit.

  2. Physiotherapy:

    • Encourages low weight-bearing activities.

    • Maintains range of motion and muscle strength.

  3. Occupational Therapy:

    • Provides adaptive equipment, joint protection techniques, and knee braces for mobility and stability.

  4. Surgical Intervention:

    • Joint Replacement Surgery (e.g., knees, hips):

      • Considered when all other treatments fail.

      • High success rates (>90% satisfaction for hips, slightly less for knees).