364 Osteoarthritis Flashcards by Medicine Katorse

Which joint is spared by osteoarthritis?

Wrist

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The most potent risk factor for OA

a. Cigarette smoking
b. Sports Injury
c. Age
d. Obesity

c. Age

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The chief cytokine synthesized by the synovium and chondrocytes is:

a. TNF alpha
b. Interleukin-1
c. MMP-13
d. ADAMTS-4

b. Interleukin-1

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The pathologic sine qua non of osteoarthritis is:

a. hyaline articular cartilage loss
b. pannus formation
c. osteophyte formation
d. “moth-eaten” bone lesion

a. hyaline articular cartilage loss

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An extremely common cause of chronic knee pain specifically located medial and inferior to the knee:

a. Trochanteric bursitis
b. Iliotibial band friction syndrome
c. Prepatellar bursitis
d. Anserine bursitis

d. Anserine bursitis

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The initial analgesic of choice for patients with OA in knee, hip, or hands is:

a. Naproxen
b. Celecoxib
c. Acetaminophen
d. Tramadol

c. Acetaminophen

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The only conventional NSAID that appears safe from a cardiovascular perspective is:

a. Rofecoxib
b. Naproxen
c. Ibuprofen
d. Mefenamic acid

b. Naproxen

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Non-inflammatory arthritis such as OA is likely if the synovial WBC count is:

a. <1000 per uL
b. 1500 per uL
c. <2000 per uL
d. >1000 per uL

a. <1000 per uL

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Which of the following is not indicated as part of the diagnostic workup for OA?

a. Synovial fluid study
b. Xray
c. MRI
d. All of the above are indicated

c. MRI

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The molecule that gives cartilage its compressive stiffness is:

a. Type 2 collagen
b. Aggrecan
c. Lubricin
d. Hyaluronic acid

b. Aggrecan

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Which of the following joints is usually spared or unaffected in osteoarthritis?

a. Cervical spine
b. First metatarsal phalangeal joint (MTP)
c. Lumbar spine
d. Ankle

d. Ankle

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True or false. Valgus (knock-kneed) malalignment predisposes to rapid cartilage loss in the lateral compartment of the knee.

True

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True or false: 2Polymorphism within the growth differentiation factor 5 gene (GDF5) is an emerging evidence that genetic mutations can confer a high risk of OA

True

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True or false. Osteophytes grow larger on the side of the joint subject to most loading stress

True

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True or false. Cartilage loss in a joint is not accompanied by pain because cartilage is aneural

True

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True or false. The severity of x-ray changes in OA correlates poorly with pain severity

True

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True or false. The simplest effective treatment for many patients is to avoid activities that precipitate pain.

True

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True or false. Weight bearing joints such as knees and hips can be unloaded by using a cane in the hand opposite to the affected joint for partial weight bearing

True

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The strongest predictor of continued exercise in a patient is a previous personal history of successful exercise

True

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True or false. There is no evidence that repeated glucocorticoid injections into the joint are dangerous.

True

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True or false. Synovial fluid lubrication depends on the presence of the mucinous glycoprotein molecule called lubricin

True

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Most common type of arthritis

osteoarthritis

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major risk factor for osteroarthritis

obesity

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commonly affected joints in OA

cervical, lumbosacral spine, hip, knee, and first metatartsal phalangeal joint (MTP)

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in the hands, which joints are affected

DIP and PIP and base of the thumb are often affected

joints usually spared

wrist, elbow and ankle

reason why the ankle is spared in OA

articular cartilage in ankle is resistant to loading stresses

universal structural changes in OA

cartilage loss and osteophytes

pathologic sine qua non of OA

hyalaine articular cartilage loss

substances serving as lubrication of the joints

hyaluronic acid and lubricin

serves as protector against friction induced cartilage wear

synovial fluid

where does the earliest chances of OA occur

cartilage and abnormalities here can accelerate disease development

major macromolecule in the cartilage which provides cartilage its tensile strength

Type 2 collagen

two major macromolecules in the cartilage

Type 2 collagen and aggrecan

gives cartilage its compressive stiffness

aggrecan

critical enzymes in the breakdown of cartilage matrix

metalloproteinases esp ADAMTS-5

most important cytokine in OA which stimulates production of proteinases and suppresses cartilage matrix synthesis

Interleukin 1 beta

how come articular cartilages are avascular

there angiogenesis inhibitors present in the cartilage

two major factors contributing to the development of OA

joint vulnerability and joint loading

True or false. Young joint with competent protectors a major acute injury or long term overloading can precipitate to OA

true.

True or false. A vulnerable joint with dysfunctional joint protectors can develop OA with minimal levels of overloading

true.

most potent risk factor for OA

age

True or false. OA is not heritable.

False. It is a highly heritable disease but its heritability is joint specific

genetic mutation associated with OA

growth differentiation factor 5 (GDF5)

most common OA among chinese

knee OA

3 uncommon developmental abnormalities in childhood that can lead to OA later in life

congenial dysplasia, Legg- Perthes disease, and slipped capital femoral epiphysis

a milder form of congenital dislocation predominantly affected girls

acetabular dysplasia

fulcrum of the longest level arm in the body

knee

location of cartilage loss. Varus or bow legged

high risk of cartilage loss in the medial or inner compartment of the knee

location of cartilage loss. Valgus or knock-kneed

high risk of cartilage loss in the lateral compartment of the knee

True or false. The relationship of weight to the risk of disease is linear so that with each increase in weight there is a commensurate increase in risk

True.

True or false. OA remains a focal disease with nonuniform loss of cartilage

True.

important radiographic hallmark of OA

osteophytes

In malaligned joints, where does the osteophytes grow

osteophytes grow larger on the side of the joints subject to most loading stress

Sources of pain in OA

synovial inflammation, joint effusion, bone marrow edema

True or false. Joint from OA is activity related

true.

where does pain come from it is trigged by climbing the stairs

patellofemoral compartment which is not active until knee is bent by 35 degrees

most common cause of chronic knee pain in persons over age 45

extremely common cause of chronic knee medial and distal to the knee

anserine bursitis

pain isolated to the area lateral to the hip joint

trochanteric bursitis

True or false. MRI is indicated as part of diagnostic workup in OA.

false.although it may reveal extent of pathology, it is not indicated

mainstay treatment in OA

altering loading across the painful joint and improving the function of joint protectors

ways of lessening focal load in the joints

avoid overloading the joint, improve strength of muscles bridging the joint; redistribute the load with a brace or a splint, cane or crutch

how much load is increased to the knee per pound increase in weight

each pound of weight increases the load across the knee by 3 to 6 fold

what is arthrogenous inhibition

contraction of muscles bridging the joint is inhibited by a nerve afferent feedback loop emanating in a swollen and stretched joint capsule

major challenge to an exercise prescription

adherence

strongest predictor of a patient's continued exercise

previous personal history of successful exercise

true or false. Nonpharmacologic approaches is the mainstay treatment in OA while pharmacologic therapy is adjunct

True

initial analgesic of choice for patients with OA in knees, hips or hands

acetaminophen or paracetamol

Maximum dosage of acetaminophen

up to 1 gram TID

most common side effect of NSAIDs

upper gastrointestinal toxicity

only conventional NSAID safe from cardiovascular perspective but has GI toxicity

naproxen

dosage of celecoxib not associated with increased cardiac risk

Celecoxib 200 mg per day or less

True or false.Topical NSAID when absorbed through the skin plasma concentrations are an order of magnitude lower than the same amount of drug administered orally or parenterally

True.

true or false. Repeated glucocorticoid injections into the joint are dangerous

false. No evidence of harm

true or false. Hyaluronic acid injection have efficacy versus placebo

false. Controversy exists regarding its efficacy

high efficacious operations for knee or hip OA who has failed medical treatment and remains in pain with limitations in physical function

total knee or total hip arthroplasty

Most

Hip Lumbar vertebra Knee

True or false. Osteoarthritis is joint failure

True

Provide tensile strength in joint

Type II collagen

What are risk factors for OA

Joint vulnerability and joint loading

Has influence in joint shape

GDF5 gene polymorphism