3: Osteoarthritis

Question 0

Inflammation- dx

Answer 0

Present
-RA, SLE, Gout
Absent
-OA

Question 1

Dx

Answer 1

Joint pattern
1: is inflammation present?
2: how many joints are involved?
3: what joints are involved?
Extra-articular manifestations (fever, rash, nodules, neuropathy)

Question 2

Site of involved joints- dx

Answer 2

DIP
-OA, Psoriatic arthritis (NOT RA)
MCP, RC
-RA, SLE (NOT OA)
1st MTP
-Gout, OA

Question 3

of joint involved- dx

Answer 3

Monoarticular
-Gout, Trauma, Septic arthritis, Lyme disease
Oligoarticular (2-4 joints)
-Reiter’s disease, Psoriatic arthritis, IBD
Polyarticular (>5 joints)
-RA, SLE

Question 4

Nodes in DIP/ PIP

Answer 4

DIP: Heberden’s node
PIP: Bouchard’s node

Question 5

Imaging

Answer 5

Standing AP & Lat views

Question 6

Management- goals

Answer 6

1: reduce pain
2: maintain mobility
3: minimize disability

Question 7

Management- drugs

Answer 7

• Acetaminophen* and NSAIDs
• Selective COX II inhibitors
• Glucocorticoid injection
• Hyaluronan
• Glucosamine and Chondroitin
• Opioids
• Capsaicin/ Rubefacients

Question 8

Surgical rx

Answer 8

• Corrective surgery
• Total knee arthroplasty (TKR)
• Unicompartmental arthroplasty
• Arthrodesis of the knee

Question 9

TKR- contraindications

Answer 9

Absolute: sepsis, ongoing primary infection, extensor mechanical damage, genu recurvatum, severe vascular disease, well-functioning arthrodesis (artificial fixation of joint)*

Relative: none

Question 10

Gout- age

Answer 10

General rule
-Uric acid levels elevated for 20 yrs before gout onset
-Tophi detected appro 10yrs after the 1st gout attack
-Male: 4-6th decades
-Female: 6-8th decades
Bofore 30th
-HGPRT deficiency
-PRPP synthetase superactivity

Question 11

Hyperuricemia- cc

Answer 11

Primary
-Lesch-Nyhan syndrome (HGPRT def)
-von Gierke disease (G-6-phosphatase def)
Secondary
-Myeloproliferative disease
-Cytotoxic drugs
-Carcinoma & Sarcoma
-Psoriasis
-Lead nephropathy (Saturnine gout)

Question 12

Gout- first attack

Answer 12

First attacks resolve spontaneously in <2 weeks

Question 13

Gout- lab

Answer 13

Arthrocenthesis: Monosodium urate crystals (+)
Polariscopic exam: Negatively birefringent; needle like; free or in neutrophils
X-ray: Punched-out erosions + overhanging rim of cortical bone: “rat bite”

Question 14

Acute Gouty Attack- rx

Answer 14

Arthritis first, hyperuricemia later
-NSAIDs: indomethacin
-Colchicine- no longer required for acute flares
-Corticosteroids
Gout & Septic arthritis can co-exist-> arthrocentesis & Gram stain should be done**

Question 15

Gout- rx btw attacks

Answer 15

• Diet
• Avoidance of hyperuricemic meds (Thiazide, Loop, Aspirin)
• Colchicine
• -1: to prevent future attacks
• -2: when uricosuric drugs/ allopurinol are started, to suppress attacks precipitated by abrupt changes of uric acid accumulation
• Uric acid serum reduction: < 6mg/L

Question 16

Gout- rx; uric acid serum reduction

Answer 16

Choice: pending 24hr urine uric acid determines

• Uricosuric
• > 800 mg/d: overproduction -> Allopurinol
• Uricosuric drugs: block tubular reabsorption
  1: Probenecid
  2: Sulfinpyrazone

Question 17

Chondrocalcinosis/ Pseudogout- info

Answer 17

Ca salts deficiency present in articular cartilage

Asso to metabolic disorders: Hemochromatosis, Wilson’s disease, Gout, Diabetes