HA, PSGAGs, PG

Question 1

4 Layers in a healthy joint:

1.
2.
3.
4.

Answer 1

1. Synovial membrane
2. Joint capsule
3. Cartilage
4. Subchondral bone

Question 2

Two layers of the synovial membranes:

1.
2.

Answer 2

1. Subintimal - blood supply and innervation

2. Intimal - synoviocytes

Question 3

Two main types of synoviocytes in the intimal layer of the synovial membrane, and their functions:

1.
2.

Answer 3

1. Macrophage Type A - phagocytosis

2. Fibroblast Type B - produce HA, aggrean, collagen, cytokines, elcosanoids, proteases

Question 4

Subchondral bone

1. Main purpose?
2. more ____ than cortical bone.
3. ____ may contribute to OA progression

Answer 4

1. shock absorber
2. deformable
3. sclerosis

Question 5

What part of the joint is used to define the health of the joint overall?

Answer 5

Articular cartilage

Question 6

Articular cartilage:

1. Creates the ____
2. Has a specialized _____ that has what confunction?

Answer 6

1. joint surface

2. extracellular matrix = distributes compressive loads

Question 7

Articular cartilage:

Composed of 80% ____, with the remaining 20% made of ___, ___, ___

Answer 7

water

PG, HA, Collagens

Question 8

Articular cartilage: Proteoglycans:

1. Have ___ and ___ components.

Answer 8

protein

GAG

Question 9

Articular cartilage: Aggrecan

1. Type of molecule?
2. Function?

Answer 9

1. Proteoglycan

2. Form aggregates with HA to protect collagens from damage

Question 10

HA

1. Backbone of the _____.
2. How it works?
3. End result?

Answer 10

1. cartilaginous matrix
2. GAGs bind to HA filament via protein link, creating a polarized charge
3. Sponge-like shock absorbing effect

Question 11

Etiology of Osteoarthritis in horses:

1.
2.

Answer 11

1. Single injury.

2. Use trauma

Question 12

Clinical parameters of OA:

1.
2.
3.

Answer 12

1. Effusion
2. Decreased viscosity of synovial fluid
3. Increased TP

Question 13

Gross cartilage changes with Osteoarthritis

1.
2.
3.
4.

Answer 13

1. Yellow
2. Fibrillated - mild OA
3. Dull
4. Ulcerated, Pitted

Question 14

Subchondral bone in Joint Disease:

1. _____ –> has what effect?
2. _____ –> has what effect?
3. ____ –> has what effect?

Answer 14

1. Sclerosis - strengthens bone
2. Osteophyte formation - bone covered in hyaline/fibrocartilage
3. Enthesiophyte formation - soft tissue attachments

Question 15

Synovial Membrane/Joint Capsule in Joint Disease:

How does it cause pain and decreased range of motion (ROM)?
1.
2.
3.

Answer 15

1. Thickening with chronic inflam
2. Hypertrophy of synovial lining
3. Fibrosis of subintima

Question 16

T/F:

Clinical signs of Osteoarthritis can be present without radiographic signs

Answer 16

T

Question 17

Goals of OA treatment:

1.
2.
3.
4.

Answer 17

1. Reduce / minimize inflam
2. Slow progression of degen
3. reduce / eliminate pain
4. Restore synovial fluid to normal

Question 18

Options to MANAGE OA disease:

1.
2.
3.
4.
5.

Answer 18

1. Chondroprotectives
2. Corticosteroids
3. NSAIDs
4. Blood based products
5. Cell based treatments

Question 19

HA:

1. Where does it come from?
2. What is it?

Answer 19

1. Type B synoviocytes, chondrocytes

2. Long unbranched non-sulfated GAG

Question 20

Functions of HA:

1.
2.
3.
4.
5.

Answer 20

1. Provides viscoelasticity, boundry lubrication
2. Modulates chemotactic response
3. Scavenges free radicals
4. Increases production of endogenous HA
5. Decreases degradation of aggrecan

Question 21

Benefits of administering HA:

1.
2.
3.

Answer 21

1. Chondroprotective (if given IA)
2. Analgesic
3. Reduces cartilage fibrillation (if given IA)

Question 22

HA Administration:

1. Amount required per joint for lameness improvement?
2. Current recommended treatment protocol?

Answer 22

1. 20 mg/joint

2. 20 mg once weekly for 3 weeks

Question 23

HA administration:

Which admin method is considered :

1. more efficiacious?
2. less effective if given to multiple joints?

Answer 23

1. IA

2. IV

Question 24

What drug can you combine Ha with to create a potent anti-inflam effect (and is recommended by Dr. Little)?

Answer 24

Triamcinolone

Question 25

PSGAGs:

1. Mechanism of how they work?
2. End Results:
   a)
   b)
   c)

Answer 25

1. unknown
2. a) Inhibits degradative enzymes

b) counteracts deleterious effects of IL-1
c) reduction of synovial effusion

Question 26

Functions of the PSGAG Adequan:

1.
2.
3.

Answer 26

1. Up-regulation of glycosaminoglycan and collagen synthesis
2. Decrease in inflam mediators
3. Improvements in synovial membrane

Question 27

1. Main drawbacks of using Adequan?

2. Solution to avoid this drawback?

Answer 27

1. Significant potentiation of subinfective dose of bacteria to produce infection
2. Admin with 125 mg IA Amikacin

Question 28

T/F: Recent research has told us that PSGAGs decrease PGE-2 in vivo, but only when administered IV

Answer 28

F, only when administered IA

Question 29

Post Surgical Lavage using Polyglycans: Options?

1.
2.
3.

Answer 29

1. Hyaluronic Acid
2. Chondroitin Sulfate
3. N-acetyl-D-glucoasamine

Question 30

Benefits of Polyglycan admin for OA patients:

1.
2.
3.

Beware what side effect:
4.

Answer 30

1. Transient improvement in lameness
2. Less bone proliferation radiographically
3. less degree of full thickness cartilage erosion
4. if given IV, can cause increase in disease progression

Question 31

When to choose HA vs PSGAGs:

1. HA is better if..
2. PSGAGs are better if:

Answer 31

1. mild synovitits/capsulitis

2. severe synovitits/capsulitis or chronic OA

Question 32

Corticosteroids:

1. Which one has chondroprotective effects?
2. Which one has dleterious effects on articular cartilage?
3. Which one is “middle of the road”?

Answer 32

1. Triamcinolone acetonide
2. Methylprednisolone acetate
3. Betamethasone

Question 33

Blood based products:

1.
2.

Answer 33

1. Autologous conditioned serum (IRAP)

2. Platelet rich plasma

Question 34

Cell based treatment options:

1.
2.
3.
4.
5.

Answer 34

1. mesenchymal stem cells
2. Adipose derived
3. BM derived
4. umbilical stem cells
5. allograft stem cells