Ch 3 - Rheumatology: OA Flashcards

1
Q

What is Osteoarthritis (OA)?

A

Nonerosive, noninflammatory progressive d/o joints l/t deterioration of the articular cartilage and new bone formation at the joint surfaces and margins

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2
Q

Which joint is MC affected with obesity?

A

Knee

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3
Q

What is seen in early pathology of OA?

A

Hypercellularity of chondrocytes
Cartilage breakdown
Increased proteoglycan synthesis
Minimal inflammation

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4
Q

What is seen in late pathology of OA?

A

– Hypocellularity of chondrocytes
– Inflammation 2/2 synovitis
– Osteophytes spur formation
– Subchondral bone sclerosis (eburnation)
– Cyst formation in the juxta-articular bone

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5
Q

What does increased water content of OA cartilage lead to?

A

Damage of the collagen network (increased chondrocytes, collagen, and enzymes)

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6
Q

Which joints are affected in primary OA?

A
Knees
MTP
DIP
CMC
Hips
Spine
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7
Q

Which joints are affected in secondary OA?

A

Elbows

Shoulders

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8
Q

What is the cause of primary OA?

A

Idiopathic

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9
Q

What is the cause of secondary OA?

A
Chronic or acute trauma
Connective tissue disease (CTD)
Endocrine or metabolic
Infectious
Neuropathic
Crystal deposition
Bone dysplasias
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10
Q

What is Diffuse idiopathic skeletal hyperostosis (DISH)?

A

Variant form of primary OA degenerative arthritis typically characterized by ossification of spinal ligaments of the thoracolumbar spine

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11
Q

Where does DISH have a predilection for?

A

Right side of the thoracic spine

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12
Q

What is the hallmark of DISH?

A

Ossification spanning three or more intervertebral discs

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13
Q

What can be seen on imaging in DISH?

A

Ossification of the anterior longitudinal ligament, separated from vertebral body by radiolucent line

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14
Q

Who is DISH most prevalent in?

A

White males >60 yo

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15
Q

What other disorders are DISH associated with?

A

DM
Obesity
HTN
CAD

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16
Q

What are clinical findings of DISH?

A

Morning or evening stiffness

17
Q

When can dysphagia be seen in DISH?

A

With cervical involvement

18
Q

What is DISH not associated with?

A

Sacroiliitis
Apophyseal joint ankylosis
HLA-B27 positivity
Distinguishes from ankylosing spondylitis

19
Q

What are symptoms of OA?

A

– 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

20
Q

What is Articular gelling?

A

Stiffness after immobility lasting short periods and dissipating after brief period of movement

21
Q

What are Heberden’s nodes?

A

osteophytosis (bone spur formation) at the DIP joints

22
Q

What are Bouchard’s nodes?

A

osteophytosis at the PIP joints

23
Q

Which CMC joint is typically affected in OA?

A

First CMC joint

24
Q

Which compartment of the knee is narrowed in OA?

A

Medial compartment

25
Which compartment of the hip is narrowed in OA?
Superior lateral compartment
26
Which MTP joint is affected in OA?
First MTP joint
27
What are radiographic findings of OA?
* Asymmetric narrowing of the joint space * Subchondral bony sclerosis * Osteophyte formation * Osseous cysts * Loose bodies
28
What is Subchondral bony sclerosis?
New bone formation (white appearance, eburnation)
29
What is not seen on radiographs in OA?
Not associated with osteoporosis/osteopenia (no bone washout)
30
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
31
What medications are used for treatment of OA?
– Acetaminophen (initial treatment) – NSAIDs (used for pain once inflammation ensues) – Narcotics—rare – Oral steroids are contraindicated