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Disease summary: Osteoarthritis

Medicine (University of Dundee)

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Osteoarthritis
A very common non-inflammatory arthritis, usually affecting the neck, back, hip,
knee, hand and feet joints. It doesn’t spare the DIP joints. It is a degenerative
disease caused by gradual wear and tear of joints  loss of cartilage during daily
life.
Aetiology:
 Mostly women over the age of 50
 Usually primary but can be secondary to
o other joint disease
o obesity
o haemochromatosis
 Occupational – heavy lifting, repetitive work
 Some forms may have a genetic component
Symptoms:
 Gradual onset of mechanical pain (as opposed to inflammatory pain in RA)
o worse on exertion; relieved by rest
o worst at the end of the day
o hip (radiating to groin) and knee pain
 Joint stiffness lasting < 30 minutes
 Crepitus – grinding/creaking of joints
 Swelling
Signs:
 Bony enlargements at DIP joints – Heberden’s nodes (think distal – D 2nd)
 Bony enlargements at PIP joints – Bouchard’s nodes (think proximal – B 1st)
 Squaring of the thumbs
 Effusions – particularly knee joint
 Baker’s cyst (swelling in popliteal fossa)
 Genu varum – bow-legged
 Osteophytes – bony projections
Pathophysiology:
Caused primarily by loss of cartilage (mostly type 2 collagen) in the joint cavity.
Mechanical wear and tear triggers inflammation, mediated by cytokines such as TNF
and interleukins. Chronic inflammation causes fibrosis – much of the joint space is
lost to this. Osteoblasts attempt to repair the worn bone, forming osteophytes (bony
spurs) which further reduce the joint space, leading to joint deformity and loss of
function. The bone becomes sclerotic (hardened). In addition, the synovium can
thicken and fluid may escape into the joint cavity, causing effusions.

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Investigations:
 Inflammatory markers – usually normal, but should be done to exclude
inflammatory arthritis
 Serum antibodies – again, will be negative for RF, anti-CCP etc.

 X-ray is gold standard:

o L – loss of joint space
o O – osteophytes
o S – sclerosis
o S – subchondral cysts

Treatment:
 Non-pharmacological
o Physiotherapy to strengthen muscles
o OT – aids, footwear
o Weight loss through low impact exercise

 Pharmacological
o Analgesia – paracetamol +/- NSAIDs
o Alternative analgesics – amitriptyline, gabapentin
o IA steroids

All of these are for symptomatic relief only.

 Surgery – joint replacement
o may be best way to improve QOL if patient can withstand surgery

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