Arthritides Flashcards
1
Q
Key manifestations of arthritis?
A
- pain, swelling and limited motion
2
Q
Diff types of jts?
A
- fibrous/bony: minimal to no motion
- cartilaginous: limited motion
- synovial:
freely mobile
compromised of 2 or more bones
may have a meniscus
3
Q
What is osteoarthritis?
A
- degenerative arthritis or jt disease, osteoarthrosis
- more than simple aging, not all old people get arthritis, absence of clear cut etiology
- loss of articular cartilage: exposed bone - leads to pain, tenderness, stiffness, effusion, loss of motion, creaking
- can develop progressive deformity, muscular atrophy and ligamentous laxity
- MC form of arthritis: affects nearly 27 mill in US, leading cause of chronic disability
4
Q
Predisposing factors for osteoarthritis?
A
- age, female sex, previous injury
- obesity: esp for knees
- heavy physical labor
- positive family hx
- sports activities
- running doesn’t appear to increase the risk: monitor sxs
5
Q
PP of OA?
A
- in most pts, trigger is damage to normal articular cartilage
- chondrocytes react by releasing degradative enzymes: can be caused by macro-trauma or repeated micro-trauma, leads to further cartilage damage
- bone reacts w/ subchondral sclerosis and osteophytes
- degradation of cartilage (trauma, aging), and bony rxn
- superficial erosions - complete loss of cartilage
- jt space narrowing and possible deformity
- hypertrophy/hyperplasia of osteocytes - leads to subchondral sclerosis - leads to osteophyte formation
6
Q
What are the features of OA?
A
- jt pain, swelling, crepitation, tenderness, effusions
- hands, hips, knees, spine: beware radiating pain and bursitis
- tenderness on palpation and on passive motion are late signs
- multiple jt involvement in older pts
- hip and knee involvement seen in the middle aged
- single jt involvement in the young: trauma or congenital abnormality
7
Q
Presentation of OA- hands?
A
- MC jt affected (70%)
- middle-aged and elderly women
- strong family hx
- DIP and PIP jts of fingers
- osteophytes and palpable***:
heberden’s nodes (DIP)
Bouchard’s nodes (PIP)
8
Q
Presentation of OA-Shoulder?
A
- progressive anterior shoulder pain, worse w/ motion
- difficulty w/ overhead activities, sleeping, axillary hygiene
- often seen w/ rotator cuff disease/tears, AC jt arthritis: spurs and AC arthritis can cause impingement of rotator cuff
9
Q
Presentation of OA-hip?
A
- 10% of pts: pain deep in groin:
pain on lateral side of hip, usually greater trochanteric bursitis, pain behind hip, usually from back - starts w/ prolonged standing/walking can become intolerable
- difficulty putting on shoes/socks - pain and loss of motion
- pain w/ abduction
10
Q
Presentation of OA-knee?
A
- 30% of pts: obesity is contributing factor
- osteophytes, effusions, crepitus, and limited motion
- difficulty: doing stairs, getting out of low chairs, off of toilets
- pain w/ kneeling/squatting - hard to get off the ground
- imaging: get standing views (AP and 45 degrees) and sunrise view
11
Q
Presentation of OA-spine?
A
- can be seen in up to 60% of pts
- sxs from facet jt arthritis and DDD (degenerative disc disease)
- cervical: pain and stiffness, aching pain down the arm: can develop cervical cord compression
- lumbar: pain across low back/buttocks w/ LOM flex/ext: can develop spinal stenosis
12
Q
How do you dx OA?
A
- clinical dx supported by H&P, lab and imaging
- no specific lab studies: r/o other arthritides (RF, ESR- rule out RA, tap the jt)
- Imaging: rarely need more than plain x-rays
13
Q
What can you see on imaging of OA?
A
- jt space narrowing
- surface irregularity
- osteophytes
- subchondral sclerosis
- subchondral cysts
14
Q
Nonpharm rx for OA?
A
- moderate wt loss
- exercises
- PT/OT
- braces
- heat/cold
- rest
15
Q
Pharm Rx for OA?
A
- acetaminophen
- NSAIDs: naproxen/ibuprofen
- Tramadol
- opioids
- intraarticular injections
16
Q
Diff types of OA intraarticular injections?
A
- both steroids and hyaluronans have been shown to be effective: can provide months of relief for many pts
glucocorticoids (triamcinolone, methylprednisolone):
-slow cartilage degradation, provide pain relief - often used in knee and shoulder, less in other jts
- repeated injections have been proven safe
- adverse effects: post injection flare, feeling high, possible infection
hyaluronans (synvisc, hyalagen):
- macromolecules that absorb water and may protect cartilage
- have been used for knees and hips
- series of injections, can have a flare, possible infection
17
Q
Process of knee injection/aspiration?
A
- thorough skin prep
- supero-lateral portal: not antero-medial
- pt supine
- sit w/ knee at eye level
- little pain when slow
- numbing skin: usually not needed
- aspiration/injection
18
Q
What non-surgical Rx for arthriti knee pain helps, what doesnt?
A
these have shown to help:
- intra-articular steroids and hyaluronans
- gentle exercises, swimming, ice
- wt loss
studies show those haven’t helped:
- orthotics
- taping
- acupuncture
- glucosamine
- chondroitin
- arthroscopic debridement
19
Q
What are surgical tx for OA?
A
- arthroscopic procedures:
no studies that show pts do anay better, may aggravate the underlying arthritis - total jt replacement:
gold std for severe knee, hip, or shoulder jt arthritis, unincompartmental replacement and resurfacing more controversial, not as clear cut for ankle, wrist, elbow - chondrocyte grafting: for small, isolated defects, no long term studies
20
Q
Total knee replacement-pros, cons?
A
- relieves pain, corrects deformity, improves fxn
- reqrs sig post-op rehabilitation
21
Q
Total hip replacement - pros, cons?
A
- relieves pain, restores fxn, relatively quick recovery - out pt
- leg length inequality not uncommon
22
Q
What are the long term issues of replacements?
A
- infections:
more susceptible due to implant - dental procedures, colonoscopy, use heart assoc guidelines for prophylaxis, sudden pain, look for infection - loosening: may be due to bone resorption or macrophage response, follow up xrays
- periprosthetic fractures:
metal creates stress risers, difficult to tx, avoid contact sports
23
Q
What is RA? Who does it commonly affect?
A
- one of the MC inflammatory arthritis: 1# of the pop, women to men 3:1
- autoimmune disease that primarily involves jts:
mult jts, often symmetrical, progresses from peripheral to proximal jts - breakdown of immune tolerance to synovial inflammation: complex interaction of genetic and enviro factors
