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Understanding Osteoarthritis | Whisper
Understanding Osteoarthritis
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01:32So L stands for loss of joint space so the joint space in the joint becomes narrower and the bones come closer to each other.
01:40O is for osteophytes and osteophytes are little spurs of bone that come out of either end at the joint.
01:49The first S is for subarticular sclerosis, and this is increased density of the bone along the joint line where the bones come in contact with each other And.
02:01The second S is for subchondral cysts and these are small fluid fill holes in the bone along the joint line.
02:11X-ray changes do not necessarily correlate with the symptoms so you might find significant x-ray changes incidentally in someone who doesn't have symptoms.
02:21Equally someone with severe symptoms of osteoarthritis might only have mild x-ray changes.
02:27So how does it present?
02:30Osteoarthritis presents with joint pain and stiffness.
02:33This pain and stiffness tends to be worsened by activity in contrast to inflammatory arthritis where activity tends to improve the symptoms.
02:43It leads to deformity of the joints, instability of the joints and reduced function in the joints.
02:52So which joints are commonly affected?
02:54Well the knees and the hips are key joints that often get affected with osteoarthritis.
03:01It can also affect the sacroiliac joints where the spinal column meets the pelvis.
03:07It typically affects the distal interphalangeal joints of the hands, the DIPs, at the ends of the fingers.
03:15The carpometacarpal 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.
03:27Let's talk about some of the signs that you might see when you examine the hands of somebody who has osteoarthritis.
03:35The first is Heberden's nodes and these occur in the DIP joints or the distal interphalangeal joints of the hands at the end of the fingers.
03:46The next is Bouchard's nodes, which are seen in the proximal interphalangeal joints of the fingers.
03:53So this is the second joint from the end of the finger.
03:56You can see squaring at the base of the thumb and this is at the carpometacarpal joint or the CMC joint There.
04:05Might be a weak or reduced grip and also a reduced range of motion in the fingers.
04:12The carpometacarpal joint at 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 it gets a lot of.
04:23Use from day-to-day activities and this makes it very prone to wear and tear when it's used for complex movements.
04:31And this is why the carpometacarpal joint is a key joint that suffers with osteoarthritis in people that use their hands a lot.
04:38Let's talk about diagnosis.
04:41Well the NICE guidelines from 2014 suggest that a diagnosis can be made without investigations if the patient's.
04:48Over forty-five if they have typical activity related pain and they don't have any morning stiffness or stiffness lasting less than thirty minutes.
04:57If they have stiffness in the morning that lasts more than thirty minutes you need to think about more of an inflammatory cause.
05:03X-rays can be helpful for checking the severity and confirming the diagnosis but they're not always necessary if the presentation is typical. Finally.
05:14Let's talk about management.
05:15It's important to start.
05:17With 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 physiotherapy to improve the strength.
05:28And 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.
05:39Activities and function as well.
05:42We can use a stepwise approach to analgesia to help control the symptoms.
05:48The first line would be starting with oral paracetamol and a topical non-steroidal anti-inflammatory like topical ibuprofen or topical diclofenac.
05:58You can also use topical capsaicin which is chili pepper extract that causes a warmth around the joint and helps to improve symptoms The.
06:07Second 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 omeprazole whilst they're using the NSAIDs.
06:22It's better to use NSAIDs intermittently rather than continuously because of the risk of affecting the stomach lining, affecting the kidneys and so on.
06:32Third line you may consider opiate medication like codeine and morphine.
06:37However these should be used very cautiously as they have significant side effects and patients also develop dependence and withdrawal.
06:46They 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.
06:57The two final things to talk about is intra-articular steroid injections which can provide temporary reduction in inflammation.
07:07And 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.
07:25Find out as more videos come out.
07:27You can also find written notes with illustrations on the Zero to Finals website at zerotofinals.com and on the website you can also find a podcast that can help you learn on the go.
07:38Questions to test your knowledge and the Zero to Finals books.
07:43Follow the link in the description to pick up a copy of the Zero to Finals medicine book.
07:47It contains detailed and concise notes on ten.
07:50Specialties in medicine and it's designed.
07:52Specifically 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.
