B6.007 Prework 2 Osteoarthritis Flashcards

1
Q

what parts of a joint can osteoarthritis affect?

A

articular cartilage, bone, synovium, and soft tissue

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2
Q

clinical presentation of OA

A

gradual onset (years)
morning stiffness < 30 min
geling phenomenon (stiffness from sitting to standing)
crepitus with movement

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3
Q

most common locations of OA involvement

A

knee
hip
hands (PIPs, DIPS, CMC)
spine (neck, lumbar)

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4
Q

epidemiology of OA

A

most common joint disorder

leading cause of disability related to pain and reduced function

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5
Q

person level risk factors for OA

A
age
female gender
joint biomechanics
inflammation
adiposity
genetics
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6
Q

joint level risk factors for OA

A

joint injury
repetitive use
malalignment / developmental changes

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7
Q

classifications of OA

A

primary (no comorbidities driving pathology)

secondary (atypical joints, young age, comorbidities present)

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8
Q

etiologies of secondary OA

A

trauma (athletes)
genetics - Stickler’s (collagen mutation)
metabolic (hemochromatosis, hyperparathyroidism, acromegaly, amyloidosis)
neuropathic/Charcot’s
hemophilia induced
hypermobility (Ehlers Danlos)

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9
Q

components of articular cartilage

A

70% water
organic compounds: type 2 collagen, aggrecan
number of other collagens, proteoglycans, and non collagenous proteins

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10
Q

what creates the tensile strength of articular cartilage

A

collagen networks

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11
Q

what creates compressive resilience in articular cartilage

A

charged proteoglycans entrap water through their hydrophilic glycosaminoglycan side chains

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12
Q

pathological findings of articular cartilage in OA

A
surface fibrillation/fissuring
chondrocyte proliferation
chondrocyte hypertrophy
tidemark duplication
subchondral bone thickening
vascular invasion of subchondral bone
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13
Q

impact of increased mechanical load on joints

A

mechanical load decreases production of sclerostin
decreased sclerostin leads to increased osteoblast bone formation
increased osteoblast bone formation leads to increased bone mass

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14
Q

what is sclerostin

A

inhibitor of Wnt pathway

regulates osteoblast mediated differentiation

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15
Q

decreased sclerostin

A

increased osteoblast production

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16
Q

impact of unloading on joints

A

increased RANKL production
increased RANKL stimulates osteoclast precursors to differentiate into osteoclasts
increased bone resorption

17
Q

xray features of osteoarthritis

A
asymmetric joint space narrowing (altered biomechanics)
subchondral sclerosis (bright white)
subchondral cysts
osteophyte formation (bone spurs)
18
Q

MRI findings of OA

A

not routine
subchondral bone marrow lesions lead to ill defined areas of hyperintensity
reflection of increased loading

19
Q

nonpharm treatments for RA

A

exercise including water based therapy
weight loss
braces (CMC, knee)
insoles

20
Q

do any OA treatments address root cause?

A

no, mainly symptomatic ttx

21
Q

side effects of NSAIDs

A

peptic ulcer (bleeding)
hypertension
worsening renal failure

22
Q

mechanism of duloxetine

A

FDA approved for OA

potent inhibitor of serotonin and NE reuptake, weak inhibitor of dopamine reuptake

23
Q

procedure based therapies for OA

A
intraarticular injections (steroids, hyaluronic acid)
joint replacements
24
Q

discuss the effectiveness of hyaluronic acid injections

A

multiple available

not demonstrated to have benefit over placebo

25
Q

mechanism behind hyaluronic acid injections

A

charged proteoglycans provide compressive resilience by entrapping water

26
Q

additional OA treatment strategies that may be individualized

A
topical therapies
supplements (glucosamine-chondroitin)
acupuncture
tai chi
mindfulness