Degenerative Joint Disease (Johnston)

Question 1

What is the most common form of arthritis worldwide?

Answer 1

Osteoarthritis (OA)

Question 2

What are some risk factors that contribute to Osteoarthritis (OA)?

Answer 2

age >55 yrs; obesity; occupations that involve physical labor or repetitive motions

Question 3

Osteoarthritis (OA)

Answer 3

non-inflammatory arthritis without systemic symptoms; pain relieved by rest; worse at the end of the day; crepitus, decreased ROM

Question 4

Pathophysiology of Osteoarthritis (OA)?

Answer 4

hyaline articular cartilage loss (predominately type 2 collagen) with increasing thickness and sclerosis of subchondral bone plate; synovial inflammation with hypertrophy and effusion leading to muscles bridging the joint

Question 5

What is the predominate type of collagen lost in Osteoarthritis (OA)?

Answer 5

type 2 collagen

Question 6

Characteristics of Osteoarthritis (OA)?

Answer 6

loss of cartilage (bone on bone)
subchondral bone thickening (sclerosis)
remodeling of bone
marginal spurs
cystic changes in the subchondral bone
shelving “fibrillated” cartilage

Question 7

shelving “fibrillated” cartilage is a characteristic of what pathology?

Answer 7

Osteoarthritis (OA)

Question 8

Answer 8

hand x ray showing Heberden’s nodes (DIP) and Bouchard’s nodes (PIP) in a patient with Osteoarthritis (OA)

Question 9

What are the common sites for Osteoarthritis (OA)?

Answer 9

cervical and lumbar spine
1st CMC (carpometacarpal - base of thumb)
PIP and DIP
Hip and Knee
1st MTP

Question 10

Joint fluid in Osteoarthritis (OA)?

Answer 10

straw-cleared colored with good viscosity; usually normal but may have a higher viscosity and more resistance

Question 11

What would you suspect to see on imaging in a patient with Osteoarthritis (OA)?

Answer 11

asymmetric joint (narrowing)
subchondral sclerosis (thickening)
marginal lipping
bone cysts

Question 12

Erosive Osteoarthritis

Answer 12

inflammatory osteoarthritis; more PAINFUL; affects DIP and PIP; more common in women; can see central erosions on radiographs with “seagull” appearance in finger joints

Question 13

central erosions on radiographs with “seagull” appearance in finger joints is characteristic of what?

Answer 13

Erosive Osteoarthritis

Question 14

the inflammatory type of osteoarthritis?

Answer 14

Erosive Osteoarthritis

Question 15

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Answer 15

non-inflammatory condition with calcification and ossification of spinal ligaments (at least 4 contiguous vertebral levels) and enthuses; common in men presents with back pain (T-spine);

Question 16

How many vertebral levels need to be involved to be diagnosed with Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

Answer 16

at least 4 contiguous vertebral levels

Question 17

What part of the spine is most commonly involved in Diffuse Idiopathic Skeletal Hyperostosis (DISH)?

Answer 17

the T-spine

Question 18

Management of Osteoarthritis (OA)?

Answer 18

there is no cure or agents approved to prevent or delay OA; management of pain NSAIDs

Question 19

What is some non-pharmacological therapy for Osteoarthritis (OA) management?

Answer 19

joint protection; **weight loss; proper footwear; strength training

Question 20

Primary joints affected in RA vs OA?

Answer 20

RA: MCP and proximal interphalangeal
OA: DIP/PIP and 1st CMC (thumb)

Question 21

Heberdens’ nodes and Bouchards nodes in RA vs OA?

Answer 21

RA: absent
OA: present

Question 22

Joint characteristics in RA vs OA?

Answer 22

RA: soft, warm and tender
OA: hard and bony

Question 23

Stiffness in RA vs OA?

Answer 23

RA: worse after rest (morning)
OA: worse after effort/activity (end of day)

Question 24

Positive laboratory findings in OA?

Answer 24

Rheumatoid factor (RF) is negative
Anti-CCP antibody negative
Normal ESR and CRP

Question 25

Positive laboratory findings in RA?

Answer 25

Rheumatoid factor (RF) is positive
Anti-CCP antibody positive
Elevated ESR and CRP

Question 26

What other diagnoses should you consider if you suspect OA?

Answer 26

Pseudogout
Gout
Psoriatic arthritis
Charcot Joint
RA