Ch 3 - Rheumatology: OA Flashcards
What is Osteoarthritis (OA)?
Nonerosive, noninflammatory progressive d/o joints l/t deterioration of the articular cartilage and new bone formation at the joint surfaces and margins
Which joint is MC affected with obesity?
Knee
What is seen in early pathology of OA?
Hypercellularity of chondrocytes
Cartilage breakdown
Increased proteoglycan synthesis
Minimal inflammation
What is seen in late pathology of OA?
– Hypocellularity of chondrocytes
– Inflammation 2/2 synovitis
– Osteophytes spur formation
– Subchondral bone sclerosis (eburnation)
– Cyst formation in the juxta-articular bone
What does increased water content of OA cartilage lead to?
Damage of the collagen network (increased chondrocytes, collagen, and enzymes)
Which joints are affected in primary OA?
Knees MTP DIP CMC Hips Spine
Which joints are affected in secondary OA?
Elbows
Shoulders
What is the cause of primary OA?
Idiopathic
What is the cause of secondary OA?
Chronic or acute trauma Connective tissue disease (CTD) Endocrine or metabolic Infectious Neuropathic Crystal deposition Bone dysplasias
What is Diffuse idiopathic skeletal hyperostosis (DISH)?
Variant form of primary OA degenerative arthritis typically characterized by ossification of spinal ligaments of the thoracolumbar spine
Where does DISH have a predilection for?
Right side of the thoracic spine
What is the hallmark of DISH?
Ossification spanning three or more intervertebral discs
What can be seen on imaging in DISH?
Ossification of the anterior longitudinal ligament, separated from vertebral body by radiolucent line
Who is DISH most prevalent in?
White males >60 yo
What other disorders are DISH associated with?
DM
Obesity
HTN
CAD
What are clinical findings of DISH?
Morning or evening stiffness
When can dysphagia be seen in DISH?
With cervical involvement
What is DISH not associated with?
Sacroiliitis
Apophyseal joint ankylosis
HLA-B27 positivity
Distinguishes from ankylosing spondylitis
What are symptoms of OA?
– Dull aching pain inc w/ activity, relieved by rest
– Later pain occurs at rest
– Joint stiffness for <30 min; worse as the day goes on
– Joint giving away
– Crepitus on ROM
What is Articular gelling?
Stiffness after immobility lasting short periods and dissipating after brief period of movement
What are Heberden’s nodes?
osteophytosis (bone spur formation) at the DIP joints
What are Bouchard’s nodes?
osteophytosis at the PIP joints
Which CMC joint is typically affected in OA?
First CMC joint
Which compartment of the knee is narrowed in OA?
Medial compartment
Which compartment of the hip is narrowed in OA?
Superior lateral compartment
Which MTP joint is affected in OA?
First MTP joint
What are radiographic findings of OA?
- Asymmetric narrowing of the joint space
- Subchondral bony sclerosis
- Osteophyte formation
- Osseous cysts
- Loose bodies
What is Subchondral bony sclerosis?
New bone formation (white appearance, eburnation)
What is not seen on radiographs in OA?
Not associated with osteoporosis/osteopenia (no bone washout)
Which joints are involved in OA in the spine?
Luschka’s (uncovertebral) joints—uncinate process on the superior/lateral aspect of the cervical vertebral bodies (C3 to C7), making them concave
What medications are used for treatment of OA?
– Acetaminophen (initial treatment)
– NSAIDs (used for pain once inflammation ensues)
– Narcotics—rare
– Oral steroids are contraindicated
