Clinical Approach to Osteoarthritis Flashcards
In general, OA =
A non-inflammatory arthritis without systemic symptoms.
What is lost structurally/molecularly in OA?
Hyaline cartilage loss, mainly type 2 collagen and proteoglycan-aggrecan.
What cytokines are seen in the synovial fluid in OA?
IL-1b and TNF-a which drive joint destruction.
What age does OA most often onset?
> 50 y/o
What are Heberdens and Bouchard nodes?
Bony enlargements of DIP and PIP joints.
What are the lab findings in a patient with OA?
Usually WNL.
What may be elevated with synovitis?
What does the synovial fluid look like?
ESR.
Straw-colored with good viscosity; WBC < 2000/uL; should evaluate for crystals.
Subchondral stenosis =
Joint mice =
Subchondral stenosis = thickening.
Joint mice = loose particles.
What form of OA is most common?
Primary OA
What is Erosive OA?
What does it affect most?
Who is it most common in?
What is seen in XR of affected joints?
Inflammatory variant.
DIP and PIP joints, more painful than typical hand OA.
F > M.
Central erosions in radiographs with “seagull” appearance in finger joints.
What is Secondary OA?
OA due to an underlying disorder and may be observed in joints not usually involved in primary OA.
Causes include trauma, infection, surgical repair, congenital abnormalities, Ca++ pyrophosphate deposits (pseudogout) or hyperparathyroidism.
What is Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
Who is it most common in?
What symptoms are seen?
What is needed for the diagnosis?
A non-inflammatory condition with calcification and ossification of spinal ligaments (anterior longitudinal l.) and enthesis.
Men
Back pain, stiffness of T-spine (no SI joint involvement).
Ossifications of at least 4 contiguous vertebral levels, usually on the right side.
