Nichola Caiger, F1

 To refresh your knowledge of: ◦ S/S of OA ◦ Risk factors for OA ◦ Investigations ◦ Management of OA ◦ Complications of OA

 Mr S is a 78 y/o man, c/o knee pain ◦ ΔΔ

 Rheumatoid arthritis  Osteoarthritis  Gout  Psuedogout  Septic arthritis  Haemarthrosis  Benign/malignant tumour  Referred pain  Muscle strain  Bakers cyst  Bursitis  Fracture  Torn ligament  Meniscal tear  Tendonitis  Etc.

 Minimal morning stiffness  Pain worse on movement  Pain worse at the end of the day  Pain relieved by rest  Often affects weight bearing joints  Reduced ROM  Joint may ‘lock’ or ‘give way’  Joint swelling and tenderness  Joints feel like they are ‘grating’ or ‘cracking’  Weakness and muscle wasting  Unilateral at onset (often bilateral with time)  Stiffness after rest  Rest pain when severe

 PMH ◦ Tibial plateau # as a teen ◦ Previous meniscectomy  FH ◦ Dad had bilateral hip replacements  DH ◦ Paracetamol & topical ibuprofen for pain  SH ◦ Retired ◦ Walks with a stick ◦ Lives in a residential home ◦ Non-smoker, tee- total  ICE ◦ Worried he won’t be able to walk any more

 Reduced ROM  Pain on movement  Joint swelling  Joint tenderness  Crepitus  Absence of systemic features suggestive of RA  Deformity  Bouchard’s/Heberden’s nodes  Joint instability  Muscle weakness/wasting

 Often a clinical diagnosis  Bedside ◦ BMI should be recorded  Bloods ◦ Usually NAD in OA  Imaging ◦ May be performed to assess joint damage or R/O differentials  Degree of damage seen does not necessarily correlate with symptom severity  Special tests ◦ Joint aspiration – R/O differentials

 Conservative ◦ Screen for low mood ◦ Promote activity and healthy diet +/- physio  Strengthens the muscles around the joint, providing extra support  Promotes weight loss  May reduce joint pain and improve joint function ◦ Patient education ◦ Walking aids and assistive devices ◦ Hot or cold packs (thermotherapy) ◦ Electrotherapy using TENS (transcutaneous electrical nerve stimulation)

 Medical ◦ Analgesia  Paracetamol and topical NSAIDs first line  Capsaicin cream  Oral NSAIDs and selective COX2 inhibitors  Intra-articular injections – corticosteroid + LA  Surgical ◦ Surgery  E.g. arthroplasty, arthrodesis, osteotomy  NB: arthroscopy usually avoided unless clear symptoms of mechanical locking

 Reduced mobility and chronic pain ◦ Loss of independence ◦ Effects on employment, social life, hobbies etc. ◦ Risk of low mood ◦ May affect quality of sleep

 Holistic approach to the patient ◦ Biopsychosocial  In finals you are expected to act like a safe F1, you do not have to know all of the answers!  Use the ABCDE approach with all acutely unwell patients  Have a system and practice using it

 is-pro is-pro  /Pages/Introduction.aspx /Pages/Introduction.aspx   arthritis arthritis  Oxford Handbook of Clinical Medicine