Osteoarthritis - clinical pattern sheet PDF

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clinical pattern sheet...

Description

Condition Osteoarthritis (OA)

Definition / Description OA is a sub type of arthritis (a disorder affecting the joints). It is degenerative breaking down hyaline cartilage which results in pain, stiffness, and bouts of inflammation. The progression of hyaline cartilage eroding can lead to bone on bone articulation within the joint, deformity or joint destruction. It can affect both larger and smaller joints of the body but more often occurs in knees, hips and lower back. Active disease process affecting the joint unit MSK disorder accompanied by inflammation represented by the elevated production of pro-inflammatory cytokines The disease has bouts of Wear – Flare – Repair Populations / Risk Factors The following show a greater prevalence on symptomatic OA:  40+ Years.  Trauma / operations which affect articulating surfaces  Occupations with demanding physical work  High impact sports.  Family history of early onset OA  Obesity Among under 50s, there is a higher prevalence for OA in men. For over 50s, there is a higher prevalence for OA in women. Symptoms Pain: Associated with long bouts of activity, worsening at the end of the day and associated with movement. Pain present is typically present in the morning or when moving after a long rest but no overnight pain. Pain can be dull and tolerable to very heavy. Stiffness: First thing in the morning or after a long period of rest, this should ease relatively quickly with gentle movement. This is not always present

Giving way: Joints give way to week muscles lax ligaments and associated reduced proprioception Sounds: Crepitus present in the joint can be audible cracking and scraping Clinical Signs Nice guidelines for OA diagnosis without investigations are: 

45 or over



has activity-related joint pain

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has either no morning joint-related stiffness or morning stiffness that lasts no longer than 30 minutes

Other signs which could be observed Crepitus: palpable creaking with movement, this is often painful (for active and passive movements). Osteophytes: boney swellings, noticeable on distal finger joints. Muscle wasting: Reduced strength and endurance, particularly noticeable on antigravity muscles. Reduced ROM: Shorting of muscles groups, incongruence of articulation surfaces. Morphological deformity of joint. Malalignment of the joint If in a state of on inflammation: A palpable general soft joint swelling, some joints can have specific swelling i.e. the back of the knee. History How long the patients have had their symptoms? (OA develops slowly) What is their pattern of stiffness throughout the day? Does exercise make their symptoms better or worse/ what type of exercise? Is there a family history of OA? Is the patient affected with symptoms generally across their whole body? (not typical for OA) Has the patient had any recent injuries? (Symptoms from an injury rather than OA) Initially OA presents with joints that appear normal, but has deep, achy joint pain exacerbated with exercise usually relieved with paracetamol and NSAIDs. Antalgic gate may be present if weight bearing joints are affected. Crepitus and reduce ROM are frequently present. As the disease progresses the joints are likely to stiffen up during rest as the disease progresses which may last up to 30 minutes after a night rest. Pain is likely to increase and may be present at rest and opioids and corticosteroids may be used to manage pain relief. Appearance of joint may change with thickening of the joint capsule, inflamed synovium, malalignment of

articulating bones and formation of osteophytes.

Investigations Radiography or CT scan: a radiographer will be able to classify the grade of OA. There are several schools of thought on how to grade OA and classification can vary from joint to joint. Atypical Presentations Rheumatoid arthritis. Psoriatic arthritis. Ankylosing spondylitis. Gout. Pseudogout (pyrophosphate arthropathy) — may coexist with osteoarthritis. Reactive arthritis. Arthritis associated with connective tissue disorders such as systemic lupus erythematosus. Fibromyalgia. Septic arthritis. Fracture of the bone adjacent to the joint. Major ligamentous injury (recent and old injuries). Bursitis. Cancer Management Options and Levels of Evidence Physical treatment options: Strengthening exercise around affected joints Aerobic fitness training. (both strengthening and aerobic land based exercises are evidenced in meta-analysis of randomly controlled trial publications). Manual therapy for the hip (manipulation and stretching). Assistive devices (for example, walking sticks, tap turners) for people who have specific problems with activities of daily living. Electrotherapy, for example TENS (transcutaneous electrical nerve stimulation). Local heat/cold. Supports and braces for people with joint pain or instability. Appropriate footwear for people with lower limb osteoarthritis.

If sufficient degeneration occurs joint replacement surgery. Useful Resources https://www.nice.org.uk/guidance/cg177/chapter/1Recommendations#diagnosis-2 https://cks.nice.org.uk/osteoarthritis#!scenario https://cks.nice.org.uk/osteoarthritis#!diagnosissub:6 http://bjsm.bmj.com/content/49/24/1554...