Degenerative bone disorders

Question 1

Which sex has the greatest incidence of OA? [1]

Answer 1

Female

Question 2

State 5 risk factors for OA

Answer 2

Abnormal mechanical loading (e.g. damaged menisci) changes the biomechanics of the joint

Inherited type two collagen defects

Obesity

Inheritance (in nodal and erosive OA)

Occupation (farmers: OA hip)

Age > 50

Question 3

Where does the Q angle run from? [3]

Answer 3

Two lines:

ASIS (Anterior superior iliac spine) to center of patella

Tibial tuberosity to the center of the patella

Question 4

What is normal Q angle? [1]

Answer 4

15 - 20 degrees

Question 5

Why are women more likely to get OA due to their Q angle? [1]

Answer 5

Bigger Q angle: more weight is directed to medial side of knee

(men put weight more centrally so is equally distributed)

Question 6

Why is exercise good in improving or slowing progression of OA? [2]

Name two risks for a weak gluteus medius [2]

Answer 6

Weak gluteal: hip not stabilised

Weak quadriceps: knee not stabilised

Weakness of gluteus medius linked to gender and obesity

Question 7

What are the three most common co-morbids. [3]

Answer 7

CVD
Cardiometabolic
Mental health

Question 8

What type of diet is recommended for OA? [1]

Answer 8

Mediterranean: Anti-inflammatory diet

Question 9

Why does obesity nutritionally increase the risk of OA? [1]

Answer 9

Poor diet may result in lack of protective nutrients and increase amounts of proinflammatory substances

Increases stress on joints and chondrocytes

Increases adipose derived inflammatory mediators

Question 10

What are the three subsets of primary OA? [3]

Answer 10

Idiopathic
Generalised
Erosive

Question 11

What are the five subsets of secondary OA? [5]

Answer 11

Mechanical incongruity of joint, congenital or acquired

Due to prior inflam. disease (RA)

Due to endocrine disorders (e.g. diabetes)

Due to metabolic disorders

Misc. (e.g. avascular necrosis)

Question 12

What are the 4 signs of OA? [4]

Answer 12

Cartilage loss:
* joint space narrowing

Bone response:
* osteophytes
* subchondral sclerosis
* trabeculae fractures/subchondral cysts

Question 13

OA diagnosis

What type of imaging would you use to ID OA in the past? [1]

Answer 13

Radiographs

Question 14

What type of imaging would you use to ID OA in present? [3]

Answer 14

MRI
Arthroscopy
Ultrasound

Question 15

Make qs on different images / signs of OA on imagin / radiographic signs of OA - e.g. spot

Question 16

Which joint is damaged by OA? [1]

Answer 16

The US examination revealed the following: on the right hip joint (left image), the contour of the femoral head is uneven and deformed, cartilage visualization is unclear and the joint capsule is thickened.

The left hip joint (right image) showed the following: the contour of the femoral head is even, cartilage surface is smooth, homogeneous, joint capsule is normal

Question 17

imaging slide

Question 18

Describe the different grades of OA [4]

Answer 18

Grade 0
* Normal

Grade 1
* Very minor bone spur no pain or discomfort (wouldn’t know that have OA)

Grade 2
* 1st time people experience symptoms, pain on walking more bone spurs

Grade 3
* Moderate OA with frequent pain and joint stiffness especially after rest, cartilage shows damage

Grade 4
* Severe OA with dramatic loss of joint space high levels of pain and discomfort during walking or moving joint

Question 19

What are the two specific types of OA that effect the hands?

Answer 19

Nodal generalised OA
Erosive OA

Question 20

Describe the nodes seen in nodal generalised OA [2]

Answer 20

Nodal generalised OA:
* DIP – Herberden’s node
* PIP – Bouchard’s node

Question 21

Which type of node is present in this OA patient? [1]

Answer 21

• PIP – Bouchard’s node

Question 22

Which type of node is present in this OA patient? [1]

Answer 22

Heberden node

Question 23

Erosive OA is a subset of which type of OA? [1]

Answer 23

nodal generalised OA

Question 24

Describe the degeneration that occurs in erosive OA [1]

Which population is most effected by erosive OA? [1]

State two disease / pathological states that OA is linked to [2]

Answer 24

Primarily characterized by erosions of cartilagein the DIP and PIP joints
* Middle finger DIP most often affected and more often symmetrical

Middle-aged or post-menopausal women are most commonly affected

Erosive OA may be linked to dyslipidaemia and metabolic syndrome

Question 25

How does erosive present undering imaging? [1]

Answer 25

Gull-wing or sawtooth

Question 26

Which inflammatory markers in erosive OA and RA? [2]

Answer 26

DRB101 and DRB107

Question 27

Explain 7 physical signs of OA

Answer 27

Crepitus
* Grinding / creaking from cracks and loss of articular cartilage

Bony enlargement
* Osteophytes

Deformity
* Osteophytes and loss of articular cartilage

Instability (pseudolaxity)
* Loss of joint space but ligaments are normal length

Restricted movement
* Osteophytes

Effusion (mild)
* Osteophytes irritate synovium and pro-inflammatory cytokines

Muscle weakness or wasting
* Pain restricts / reduces joint use

Question 28

Label these signs of OA

Answer 28

A: osteophytes
B: tibial spiking
C: irregularity
D: narrowing

Question 29

What sign is outlined in this patient with OA? [1]

Answer 29

sclerosis

Question 30

What sign is outlined in this patient with OA? [1]

Answer 30

Osteophytes

Question 31

What sign is outlined in this patient with OA? [1]

Answer 31

subchondral cysts