4. Clinical Approach to Osteoarthritis Flashcards
Osteoarthritis is the MC form of arthritis worldwide, leading cause of pain and disability of LE among older patients, high prevalence and projected to double due to increasing obesity rates and aging populations, risk factors include age >55, female, obese, occupations, genetic mutations, joint loading injury/trauma, malalignment and what?
Injury***
OA is characteristically non*-inflammatory arthritis wihtout systemic symptoms, pain is relieved by rest and morning stiffness is BREIF, oligoarticular meaning?
a few joints involved
Pathophys: combination of multifactorial stressors including consequences of aging, hyaline articular cartilage loss** (type 2 collagen and aggrecan), increasing thickness and sclerosis of subchondral bone plate, outgrowth of osteophytes at the joint margin, ECM degeneration and?
Joint injury
Synovial inflammation with hypertrophy and effusion, inflammatory cytokines such as interleukin 1B and TNF-A that drive tissue destruction*, weakness of what bridgin the joint?
Muscles
OA characteristics include loss of cartilage, subchondral bone thickening and sclerosis and cystic changes, remodeling of bone, mild reactive synovitis, and marginal spurs known as?
osteophytes
OA usually affects weight bearing joints and frequently used joints such as hips, knees, spine, hands (MC= DIP, PIP 1st CMC = thumb base), usually pts are >50, insidious onset of intermittent symptoms becoming more severe over time, morning stiffness less than 30 minutes and pain is worse when?
with ACTIVITY- alleviated with rest
OA is associated with crepitus, decreased ROM, and a COLD effusion, hip involvement manifests as groin pain, knee symptoms = pain on walking and climbing stairs, spondylosis = OA of spine can lead to spinal stenosis, leading to joint instability, what nodes are bony enlargements of DIP and PIP joints respectively?
DIP (distal finger)= Heberdens Nodes
PIP (Proximal finger)= Bouchard Nodes
OA is common in cervical and lumbar spine, 1st. CMC, PIPs, DIPs, Hips, knee and the first?
big toe/ thumb
Lab studies associated with OA are usually normal, ESR may be slightly elevated with synovitis and the joint fluid is straw-clear colored with good viscosity and WBCs <2000, if a tap is done, make sure to check for crystals and?
infection
On imaging with OA, one can see asymmetrical joint and space narrowing, subchondral sclerosis (thickening), osteophytes and marginal lipping (bony overgrowth), bone cysts and what within the joint which are loose particles?
Joint mice
Primary OA is the MC classification, there is no identifiable cause recognized, the MC joints affect are DIPs and PIPs of the fingers and the 1st carpometacarpal joint at the base of the thumb along with hip and knee joints, cervical and?
lumbar spine
What OA is more common in women and affects DIPs/PIPs with MORE pain than typical, there are central erosions on radiographs (marginal erosions seen in RA), with seagull* appearance in finger joints more common?
Erosive OA (inflammatory)
What OA is due to a secondary disorder and may be observed in joint but not typically involved in primary OA, such as trauma, joint infection, surgical repair, congenital joints, metabolic or endocrine– for example hemochromatosis (Fe overload) affecting 2nd/3rd MCP joints and wrist?
Secondary OA
Other causes of secondary OA include calcium pyrophosphate deposits (pseudogout) with OA in MCP, wrist, knees, hips and shoulders, what cause of secondary OA has OA in the wrist of MCP most commonly?
Hyperparathyroidism
NOTE: most causes are primary
What is ankylosis?
When the joint space is taken over by bone formation and lacks movement
What is the following describing?
metacarpophalangeal joint affected and PIP
no heberdens nodes
joint is soft warm and tender
worse after resting and prolonged morning stiffness (>30)
positive for rheumatoid factor/anti-CCP antibody
elevated ESR and CRP
Rheumatoid Arthritis
DDx for OA includes calcium pyrophosphate deposition (psedogout-hands/knees, xray shows carilage calcification), gout can coexist with OA in DIP, psoriatic arthritis can involve DIP, along with carchot joint, osteonecrosis and of course?
Rheumatoid Arthritis
What is a non-inflammatory condition in which there is calcification and ossification of spinal ligaments (MC=ant longitudinal ligament) and enthesis (tendon and ligament attachments to bone), MC in MEN, back pain and stiffness, T spine MC involved, no SI involvement, ossifications of at least 4 continuous vertebral levels, usually on right side of spine?
DISH: Diffuse Idiopathic Skeletal Hyperstosis
To date there is no tx for OA, management of pain and disability and non-pharmacologic therapy such as education, joint protection, proper footwear, cane, bracing, isometric-aerobic excercise, strength training and MOST importantly?
Weight loss
Pharmacologic therapy includes NSAIDs, duloxetine, tramadol, acetaminophen, COX2 inhib, topical capsaicin cream, topical NSAIDs, intra articular injections with glucocorticoids and what which can get infection and cause hardware loss?
Total Joint Replacement*
NOTE: glucosamine/chondroitin failed to show efficacy for pain relief
