Wear and tear (of bone/cartilage/synovial joint) arthritis – most common locomotor disability. Now thought to be metabolically active process.
- RFs: increasing age, female, black/asian, genetics/FH, obesity, abnormal joint loading de to previous injury, weak muscles, certain occupations (farming)…
- P/c: pain in joint, stiffness, synovial capsule tightening and thickening, deformity (odd bone angulation), effusions, creps, weakness and wasting, loss of function, painful exacerbations last weeks/months, affects hips, knee, base of thumb (CMC joint), can be nodal with distal interphalangeal joint involvement (Heberden’s nodes).
- Ix: XR (=reduced joint space, cysts, sclerosis in subchondral bone), and osteophytes (‘spurs’). FBC, ESR (may be mildly raised in OA), if >30 = suggestive of RA/psoriatic arthritis.
- o In Primary care: advice, physio/OT if indicated, reduce loading on joint (weight reduction, stick, cushioned insoles), increase exercise and improve muscle strength (will reduce pain and disability).
- o Pain control: paracetamol 1g QDS, NSAIDs may help – topical have fewer s/e than oral, ‘counter-irritants’ (capsaicin cream) may also help. Local heat or cold may help, low dose anti-depressants (amitriptyline 10-75mg nocte may help).
- o Complementary therapies: aspirate joint for exacerbation relief, intra-articular steroid injections, hyaluronic acid injections help in short term, glucosamine 1500mg/d may help, copper bracelets, dietary manipulation, accupunctrue.
- Refer to rheumatology = rule out secondary causes (pseudogout, haemochromatosis) if pt young or odd distribution.
- Refer to orthopaedics = severe and require replacement.