Understanding Osteoarthritis

hi this is tom from zero to finals calm in this video I'm going to be going through osteoarthritis and you can find written notes on this topic at zero to finals comm /o a or in the Rheumatology section of the zero finals medicine book so let's jump straight in osteoarthritis is often described as wear and tear in the joints it's not an inflammatory condition like rheumatoid arthritis and it occurs in the synovial joints and it's a combination of genetic factors overuse and injury to the joint risk factors for osteoarthritis include obesity increased age occupation particularly occupations where there's a high usage of particular joints trauma to the joint being female and also a family history of osteoarthritis it's thought to be the result of an imbalance between the cartilage being worn down and the chondrocytes repairing that cartilage and this leads to structural issues within the joint that causes more wear and tear and pain these abnormalities can be seen on an x-ray and the key mnemonic for remembering the four key x-ray changes in osteoarthritis is loss l o SS so L stands for loss of joint space so the joint space in the joint becomes narrower and the bones come closer to each other o is for osteophytes and osteophytes a little Spurs of bone that come out of either end at the joint the first s is for sub articular sclerosis and this has increased density of the bone along the joint line where the bones come in contact with each other the second S is for subchondral cysts and these are small fluid fill holes in the bone along the joint line x-ray changes do not necessarily correlate with the symptom so you might find significant x-ray changes incidentally and someone who doesn't have symptoms equally someone with severe symptoms of osteoarthritis might only have mild x-ray changes so how does it present osteoarthritis presents with joint pain and stiffness this pain and stiffness tends to be worsened by activity in contrast to inflammatory arthritis where activity tends to improve the symptoms it leads to deformity of the joints instability of the joints and reduced function in the joints so which joints are commonly affected well the knees and the hips are key joints that often get affected with osteoarthritis it can also affect the sacroiliac joints where the spinal column meets the pelvis it typically affects the distal interphalangeal joints of the hands the DI pees at the ends of the fingers the carpo metacarpal joint at the base of the thumb or the CMC joint at the base of the thumb the wrist and then the cervical spine which we often call cervical spondylosis about some of the signs that you might see when you examine the hands of somebody who has osteoarthritis the first is habit ins modes and these occur in the di P joints or the distal interphalangeal joints of the hands at the end of the fingers the next is bouchard's nodes which are seen in the proximal interphalangeal joints of the fingers so this is the second joint from the end of the finger you can see squaring at the base of the thumb and this is at the capo metacarpal joint or the CMC joint there might be a weak or reduced grip and also a reduced range of motion in the fingers the copper metacarpal jointer the base of the thumb is a saddle joint with the metacarpal bone of the thumb sat on the trapezius bone using it like a saddle and he gets a lot of use from day to day activities and this makes it very prone to wear and tear when it's used for complex movements and this is why the copper metacarpal joint is a key joint that suffers with osteoarthritis in people that use their hands a lot let's talk about diagnosis well the nice guidelines from 2014 suggests that a diagnosis can be made without investigations if the patients over 45 if they have typical activity related pain and they don't have any morning stiffness or stiffness lasting less than 30 minutes if they have stiffness in the morning the last more than 30 minutes you need to think about more of an inflammatory cause x-rays can be helpful for checking the severity and confirming the diagnosis but they're not always necessary if the presentation is typical finally let's talk about management it's important to start with patient education about the condition and advise them on lifestyle changes like losing weight if they're overweight and this helps reduce the load on the joint vizier therapy to improve the strength and support of the joints and also occupational therapy can be helpful in terms of how to maximize the function of the remaining joint and orthotics can be used to help support activities and function as well we can use a stepwise approach to analgesia to help control the symptoms the first line will be starting with oral paracetamol and a topical nonsteroidal antiinflammatory like topical ibuprofen or topical diclofenac and you can also use topical capsaicin which is chili pepper extract that causes a warmth around the joint and helps to improve symptoms the second step is to add oral non-steroidal anti-inflammatory medications like ibuprofen or naproxen and also consider prescribing a proton pump inhibitor to protect their stomach such as a metro sole whilst they're using the NSAIDs it's better to use NSAIDs intermittently rather than continuously because of the risk of affecting the stomach lining affecting the kidneys and so on third line you may consider opiate medication like codeine and morphine however these should be used very cautiously as they have significant side-effects and patients also develop dependence and withdrawal they also don't work for chronic pain because they're useful for a couple of weeks and then they stop having an analgesic effect and the patient becomes dependent on them without actually getting any benefit the two final things are talked about is intra-articular steroid injections which can provide temporary reduction in inflammation and improve the symptoms and the other is joint replacement which can be used in severe cases and the hips and the knees are the most commonly replaced joints thanks for watching this video if you found it helpful please consider giving it a thumbs up and subscribing to follow the channel and find out as more videos come out you can also find written notes with illustrations on the zero to finals website at zero define as calm and on the website you can also find a podcast that can help you learn on the go question to test your knowledge and the zero to finals books follow the link in the description to pick up a copy of the Z road finals Medicine book it contains detailed and concise notes on ten specialties in medicine and it's designed specifically to contain the key facts and guidelines you need to know for your medical exams with mnemonics and Tom tips to help you learn exactly what you need to know for your exams without all the hassle follow the links to find out more

Channel: Zero To Finals

Views: 352,419

Keywords: medical, education, medicine, doctor, osteoarthritis, rheumatology, arthritis, orthopaedics, orthopedics, medical student, nursing

Id: CYTGpcPz3dg

Length: 8min 6sec (486 seconds)

Published: Thu Oct 17 2019