2- Osteoarthritis (DJD)

Question 1

What is the most common form of joint disease?

Answer 1

OA

Question 2

What does OA mainly result from? What are some other factors?

Answer 2

Aging
Hereditary and mechanical factors
Obesity it also a risk factor (knee, hand, hip)

Question 3

In which sex does OA develop more frequently?

Answer 3

Women

Question 4

What is OA characterized by?

Answer 4

• Degeneration of cartilage

- Hypertrophy of bone

Question 5

What are the two main types of OA and where do they occur?

Answer 5

Primary (DIP, PIP, hip, knee, CMC of thumb, MTP, cervical and lumbar spine)
Secondary (sequela to articular injury)

Question 6

What are the signs and symptoms of OA?

Answer 6

• insidious onset
• articular stiffness
• pain on motion
• flexion contracture or varus deformity of the knee
• limitation of motion
• crepitus
• joint effusion
• no systemic manifestations

Question 7

What are the laboratory findings associated with OA?

Answer 7

No elevation of ESR

Synovial fluid is noninflammatory

Question 8

What are the imaging findings associated with OA?

Answer 8

• narrowing of the joint space
• osteophyte formation
• lipping of marginal bone
• thickened, dense subchondral bone
• bone cysts

Question 9

What are some differential diagnoses associated with OA?

Answer 9

• rheumatoid arthritis
• skeletal symptoms due to degnerative changed in joints (esp spine)…coexistant metastatis neoplasia, osteoporosis, multiple myeloma, other bone disease cna be overlooked

Question 10

What are some ways to prevent OA??

Answer 10

• weight reduction
• correcting leg length discrepancy of > 1 cm
• maintain normal vitamin D levels

Question 11

What are some general measures that can be taken to help treat OA?

Answer 11

• assistive devices
• splinting
• regular exercise program
• losing weight

Question 12

What are some ways of managing OA medically?

Answer 12

• Acetaminophen
• NSAIDs (Nonsteroidal anti-inflammatory drugs)
• Topical capsaicin
• Chondroitin Sulfate and glucosamine

Question 13

______ is more effective than ______, but has a greater toxicity

Answer 13

NSAIDs, Acetominophen

Question 14

How do NSAIDs work?

Answer 14

selective COX-2 inhibitors (Celecoxib)

Question 15

What are some side effects of NSAIDs?

Answer 15

• GI toxicity
• Acute liver injury
• Renal toxicity (and high blood pressure)
• Hyperkalemia
• Interference with platelet function/prolonged bleeding time

Question 16

Which drug has more of a risk of liver toxicity?

Answer 16

Acetominophen

Question 17

What types of intra-articular injections can be given for OA?

Answer 17

Steroids (triamcinolone)

Sodium hyaluronate

Question 18

What surgical measures are there for OA?

Answer 18

Total hip and knee replacements

Question 19

What is the prognosis for someone with OA?

Answer 19

Symptoms may be quite severe and limit activity considerably

Question 20

When should we refer a patient to an orthopedic surgeon when…

Answer 20

recalcitrant symptoms or functional impairments or both warrant consideration of joint replacement surgery