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MSK II Final > Cox: Arthritis CIS > Flashcards

Cox: Arthritis CIS Flashcards

1
Q

What kind of nodes would we find in OA

A
  • Herberden’s

- the ones in the DIPs

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2
Q

What would we find in the synovial fluid if there we had a gouty joint?

A

-Urate crystals

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3
Q

RA

A
  • morning joint stiffness, RF, Elevated ESR and CRP
  • Antibody to CCP
  • Lon standing RA may develop secondary OA
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4
Q

-Psoriatic Arthritis

A

-May taget 1 DIP, nail changes

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5
Q

Crystalline Arthritis

A
  • Syovial fluid

- urate crystals, gout

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6
Q

Hemochromatosis

A
  • FE overload

- MCP, wrists

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7
Q

Infectious

A
  • Leukocytosis

- synovial or blood culture

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8
Q

OA

A
  • degenerative joint disease (DJD)
  • Most common joint disease
  • Characteristically non-inflammatory
  • Lack of systemic symptoms
  • pain releived by rest, if present- morning joint stiffness is brief
  • Oligoarticular
  • Generalized
  • Aging phenomenon
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9
Q

OA/DJD characteristics

A
  • Bony changes in joint shape
  • crepitus
  • malalignment/instability
  • Limited ROM
  • Joint line tenderness
  • Cool effusions
  • Spasm or atrophy of adjacent muscles
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10
Q

Which regions are commonly affected by OA?

A
  • Cervical spine
  • lumbar spine
  • PIP
  • DIP
  • hip
  • knee
  • 1st MTP
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11
Q

What would a patient’s hip look like with OA on an xray?

A

-sclerosis of femoral head

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12
Q

OA radiographic findings

A
  • joint space narrowing
  • osteophytes and marginal lipping
  • subchondral thickening
  • bone cysts
  • joint mice
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13
Q

do radiographic findings always directly correlate to degree of symptoms?

A

-no

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14
Q

What causes the breakdown of cartilage in OA?

A
  • Damage from physical forces
  • so chondrocytes react and release degradative enzymes and there is an inadequate repair response
  • drop-out, cartilage loss, bone changes, loose bodies (joint mice)
  • Fundamental defective cartilage fails under normal joint loading
  • Type 2 collagen gene defect
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15
Q

What is the new articular surface in OA?

A
  • subchondral bone
  • friction, bone eburnation
  • sclerosis, small fracture, synovial fluid contating cyst
  • altered bone contour, lipping
  • osteophyte at margin as fibrocartilage and hyaline cartilage ossify
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16
Q

OA heredity

A
  • risk of OA= sum of multiple genes
  • genetically heterogeneous
  • Heritable component…. particularly at hip
  • generalized osteoarthritis characterized by osteophytes of the HIP (Heberden’s nodes) and PIP joints (bouchard’s nodes)
17
Q

Primary OA

A
  • Aging or idiopathic

- genetic: nodal OA

18
Q

Secondary OA

A

-disorders that damage joint surfaces

19
Q

OA characteristics

A
  • Altered chondrocyte function
  • loss of cartilage: thinning
  • Subchondral bone thickening: sclerosis
  • Remodeling of bone
  • Marginal spurs: osteophytes
  • Subchondral bone: cystic changes
  • Mild reactive synovitis
20
Q

Main distinguishing factors between OA and RA

A
  • OA has:
  • DIP and carpometacarpal joints affected
  • heberden’s nodes
  • hard and bony joints
  • worse after effort
  • not as much morning stiffness
  • RF and Anti CCP negative
  • Normal ESR and CRP
21
Q

Hyperostosis

A
  • Diffuse idiopathic skeletal hyperostosis (DISH)
  • old ppl
  • frequently but not always asymptomatic
  • cervical spine=dysphagia
  • Osteophytosis of spine… spans >3-4 segments
  • Paraspinous ligaments= calcifications/ossification
  • preservation of disc space
  • some association with DM
22
Q

What is the characteristic finding for hyperostosis

A
  • flowing wax appearance on anterior vertebral bodies

- remember that the joint spaces are relatively normal

23
Q

Management of OA

A
  • no cure
  • pain control
  • minimize disability
  • Improve quality of life
  • education
  • surgery
  • nonpharmacologic: OMT to address compensatory changes, exercise, PT, OT, wt loss, acupuncture
24
Q

What is the first pharmacologic action we would take in someone with OA?

A

-Acetaminophen

25
Q

What other pharm things could we do for an OA patient

A
  • Acetaminophen
  • NSAID
  • Capsaicin
  • Intraarticular glucocorticoids
26
Q

If symptomatic relief is inadequate, what else should we consider?

A
  • intraarticular hyaluronic acid
  • platelet rich plasma
  • glucosamine and chondroitin
  • opioid analgesics

MSK II Final (13 decks)

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