Degenerative Joint Disease (Johnston) Flashcards
What is the most common form of arthritis worldwide?
Osteoarthritis (OA)
What are some risk factors that contribute to Osteoarthritis (OA)?
age >55 yrs; obesity; occupations that involve physical labor or repetitive motions
Osteoarthritis (OA)
non-inflammatory arthritis without systemic symptoms; pain relieved by rest; worse at the end of the day; crepitus, decreased ROM
Pathophysiology of Osteoarthritis (OA)?
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
What is the predominate type of collagen lost in Osteoarthritis (OA)?
type 2 collagen
Characteristics of Osteoarthritis (OA)?
loss of cartilage (bone on bone)
subchondral bone thickening (sclerosis)
remodeling of bone
marginal spurs
cystic changes in the subchondral bone
shelving “fibrillated” cartilage
shelving “fibrillated” cartilage is a characteristic of what pathology?
Osteoarthritis (OA)
hand x ray showing Heberden’s nodes (DIP) and Bouchard’s nodes (PIP) in a patient with Osteoarthritis (OA)
What are the common sites for Osteoarthritis (OA)?
cervical and lumbar spine
1st CMC (carpometacarpal - base of thumb)
PIP and DIP
Hip and Knee
1st MTP
Joint fluid in Osteoarthritis (OA)?
straw-cleared colored with good viscosity; usually normal but may have a higher viscosity and more resistance
What would you suspect to see on imaging in a patient with Osteoarthritis (OA)?
asymmetric joint (narrowing)
subchondral sclerosis (thickening)
marginal lipping
bone cysts
Erosive Osteoarthritis
inflammatory osteoarthritis; more PAINFUL; affects DIP and PIP; more common in women; can see central erosions on radiographs with “seagull” appearance in finger joints
central erosions on radiographs with “seagull” appearance in finger joints is characteristic of what?
Erosive Osteoarthritis
the inflammatory type of osteoarthritis?
Erosive Osteoarthritis
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
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);
How many vertebral levels need to be involved to be diagnosed with Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
at least 4 contiguous vertebral levels
What part of the spine is most commonly involved in Diffuse Idiopathic Skeletal Hyperostosis (DISH)?
the T-spine
Management of Osteoarthritis (OA)?
there is no cure or agents approved to prevent or delay OA; management of pain NSAIDs
What is some non-pharmacological therapy for Osteoarthritis (OA) management?
joint protection; **weight loss; proper footwear; strength training
Primary joints affected in RA vs OA?
RA: MCP and proximal interphalangeal
OA: DIP/PIP and 1st CMC (thumb)
Heberdens’ nodes and Bouchards nodes in RA vs OA?
RA: absent
OA: present
Joint characteristics in RA vs OA?
RA: soft, warm and tender
OA: hard and bony
Stiffness in RA vs OA?
RA: worse after rest (morning)
OA: worse after effort/activity (end of day)
Positive laboratory findings in OA?
Rheumatoid factor (RF) is negative
Anti-CCP antibody negative
Normal ESR and CRP
Positive laboratory findings in RA?
Rheumatoid factor (RF) is positive
Anti-CCP antibody positive
Elevated ESR and CRP
What other diagnoses should you consider if you suspect OA?
Pseudogout
Gout
Psoriatic arthritis
Charcot Joint
RA
