[CLMD] Osteoarthritis(OA) and Degenerative Joint Disease(DJD) [Johnston]

Question 1

Prevalence of OA is increasing due to what 2 factors?

Answer 1

Obesity and Aging populations

Question 2

OA is associated with what type of collagen loss?

Answer 2

Type 2 Collagen

Question 3

Synovial inflammation with hypertrophy and effusion is seen with what?

Answer 3

Osteoarthritis

Question 4

What are hallmark characteristics of OA?

Answer 4

Loss of cartilage

Marginal spurs (osteophytes)

Subchondral bone

Altered chondrocyte function

Question 5

Which joints most often affected in OA?

Answer 5

• Weight bearing joints and frequently used joints
• Hips, knees, spine
• Hands: DIP, PIP, and 1st CMC - thumb base

Question 6

Whta is the common name of the “crunchy” sound with an OA joint moving?

Answer 6

Crepitus

Question 7

Hip involvement in OA most commonly manifests as what sx?

Answer 7

Groin pain

Question 8

What are the lab findings with OA?

Answer 8

Usually normal!!!

Question 9

What is the Erosive subtype of OA; seen most often in whom?

Answer 9

• Affects DIP and PIP joints; more painful than typical hand OA
• More common in women

Question 10

What is commonly seen on radiographs in pt with Erosive OA and how can it be differentiated from RA?

Answer 10

Central erosions (vs. marginal erosions in RA) w/ “seagull” appearance in finger joints

Question 11

Which underlying GI disease can lead to secondary OA; which joints most often affected?

Answer 11

• Hemochromatosis
• 2nd/3rd MCP joints and wrist

Question 12

Which endocrine abnormality can manifest as secondary OA; which joints most often affected?

Answer 12

• Hyperparathyroidism
• Wrist, MCP

Question 13

What is seen with diffuse idiopathic skeletal hyperostosis (DISH); what are the criteria?

Answer 13

• Calcification and ossification of spinal ligaments i.e., anterior longitudinal ligament and enthesis (tendon/lig. attachement to bone)
• No SI joints involvement*
• Ossifications of at least 4 contiguous vertebral levels, usually on the right side of spine

*TYPICALLY MEN

Question 14

What are the non-pharmacologic appraoches to tx OA?

Answer 14

• Education on OA and joint protection
• Weight loss
• Proper footwear + cane + bracing
• Isometric - aerobic exercise + strength training

Question 15

What are the primary joints affected in:

RA

OA

Answer 15

RA = Metacarpophalangeal, Proximal interphalangeal

OA= Disteal interphalangeal, Carpometacarpal

Question 16

What time of day is each WORSE?

RA

OA

Answer 16

RA = Worst in the morning

OA= Worst in the evening

Question 17

Laboratory findings:

RA

OA

Answer 17

RA = (+) Rheumatoid factor, (+) Anti-CCP antibody, Elevated ESR and CRP

OA = Normal ESR and CRP

Question 18

What are the joint characteristics of:

RA

OA

Answer 18

RA = Soft, warm, tender

OA = Hard and bony