Arthritis: Do I have it?
Part 5
We continue our discussion of the topic Arthritis which we started four (4) Sundays ago.
Signs and symptoms of osteoarthritis (OA)
Signs – These are some of the signs of OA: Loss of joint space, Joint grinding/grating, Bony outgrowths (osteophytes), and Joint deformities e.g. Heberden’s nodes
Symptoms – These are some of the symptoms of OA: Use-related joint pain, Joint stiffness after periods of inactivity, Loss of joint movement/difficulty performing certain tasks, Joint locking/giving way, Feeling of instability, Restricted/painful movements
Joint involvement in OA
Common: Knee, Hip, Fingers, Spine
Less common: Elbow, Shoulder, Wrist and Ankle
Deformities in OA
*Knee deformity in OA
*Finger deformities in OA
Deformities can occur at:: the base of the thumb (Bouchard’s nodes), the middle joint of a finger (Bouchard’s nodes), and the finger tip (Heberden’s nodules)
Below is the World Health Organisation (WHO) analgesic ladder:
Increasing pain
1) Simple analgesics – e.g. paracetamol or NSAIDs;
2) Weak opiates – e.g. codeine or dihydrocodeine + simple analgesics; and 3) Strong opiates e.g. morphine or diamorphine + simple analgesics
Recommended treatments for OA
Increasing pain
1) Non-pharmacological treatments – Paracetamol plus topical NSAIDs; 2) Add NSAIDs: patients at increased GI risk to use NSAID plus gastroprotectant or COX-2; 3) Consider opiates e.g. tramadol; and 4) Add intra-articular injection of long-acting corticosteroid Consider joint replacement