Joint Disorders Flashcards by Anna L

What are the most common joint disorders?

Chondrolysis
Osteoarthritis
Degenerative Intervertebral Disk Disease (Spine)
Rheumatic Diseases
Neuroarthropathy

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What is chondrolysis?

process of rapid cartilage degeneration (which narrows the joint space)

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Where/when is chrondrolysis most common?

Hip; slipped capital femoral epiphysis

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What population is chrondrolysis most commonly seen in?

Females; most common onset is during adolescence

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The degeneration process of chrondrolysis is associated with….?

infection
trauma (including ortho surgeries)
prolonged immobilization

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Chondrolysis typically manifests how?

progressive joint stiffness, with progressive loss of motion and pain;
anterior hip/groin pain w/ antalgic gait
soft tissue contracture results in different leg-length

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How do you diagnose chondrolysis?

Imaging studies (radiographs, MRI) you’re looking for joint narrowing

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How to treat chondrolysis?

NSAIDs to control synovial inflammation
protected weight bearing
surgery

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What is osteoarthritis (OA)?

slowly evolving articular disease that affects:
bone
soft tissues
synovial fluid

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Where does OA originate?

in the cartilage

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Cause of primary OA

unknown

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Cause of secondary OA

trauma
infection
hemarthrosis (bleeding into a joint/joint space)
osteonecrosis

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What is the most common joint disease?

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After age __, __ of men and __ of women have OA?

65 years old, 60% of men, 70% of women

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What is the most common musculoskeletal disorder worldwide affecting the hands and large weight-bearing joints (hip & knee?

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Developing OA is a risk factor for you to develop _________?

cardiovascular disease

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Risk factors for OA

Genetics
Injuries to joints & surrounding structures
Muscle weakness (from immobilization, polymyositis, multiple sclerosis, myopathies)

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Pathogenesis????

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Onset of OA symptoms occurs ________?

insidiously or suddenly

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OA symptoms

Joint stiffness
Swelling (mild and localized to joint)
Loss of flexibility
Crepitus

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OA:
How long does morning stiffness last?
How long does stiffness last after inactive periods?

5-10 min; < 30 min

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OA of hands occurs most often in ______ and affects what 2 joints?

women; DIP, PIP

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OA typically develops within ______ of ___________ and is often associated with mild inflammation for _________ that a particular joint is involved?

within a few years of menopause

the first year or two

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Heberden vs Bouchard nodes

enlarged joints via osteophyte formation
Heberden nodes affect the DIP
Bouchard nodes affect the PIP

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radiographic changes associated with OA

Joint space widening (early evidence) Subchondral bone sclerosis Subchondral bone cysts Osteophytes Joint space narrowing

Kellgren and Lawrence Grading System for Knee: Grade 1

Possible osteophytes; no joint space narrowing

Kellgren and Lawrence Grading System for Knee: Grade 2

Definite osteophytes; possible narrowing of joint space

Kellgren and Lawrence Grading System for Knee: Grade 3

Moderate multiple osteophytes; definite joint space narrowing; some sclerosis and possible deformity of bone ends

Kellgren and Lawrence Grading System for Knee: Grade 4

Large osteophytes; marked joint space narrowing; severe sclerosis and definite deformity of bone ends

OA treatment

conservative care (EX. education, psychosocial, low-impact exercise, braces) pharmacotherapy (EX. acetminophen, NSAIDs, Injection) surgery (considered when pain and loss of function is severe)

Mobility disability definition

needing help walking or climbing stairs

mobility disability is common for people with ____ or _____ OA

hip; knee

rheumatic diseases refer to

systemic disorders encompassing more than 100 different diseases divided into 10 classification categories

EX of rheumatic diseases

Rheumatoid Arthritis Juvenile Idiopathic Arthritis Spondyloarthropathies- Ankylosing Spondylitis Diffuse Idiopathic Skeletal Hyperostosis Sjögren Syndrome Psoriatic Arthritis Reactive Arthritis Reiter Syndrome

rheumatoid arthritis (RA) definition

chronic systemic inflammatory disease that manifests with a wide range of articular and extraarticular findings

articular findings of RA

chronic polyarthritis, a gradual destruction of joint tissues; can result in severe deformity and disability

extraarticular findings of RA

CV, Pulmonary, GI systems eye lesions, infection, osteoporosis

% of US adults with RA

~1-2%

T/F: RA is more prevalent than OA

False, RA is the 2nd most prevalent form of arthritis AFTER OA

Primary risk factors for RA

Age and Gender (females more affected than men)

Peak onset age of RA

between 30 and 60 y/o

What kind of cells infiltrate the synovial fluid in RA?

immune cells, especially T lymphocytes

Approx. __% of people with RA are rheumatoid factor-positive

80%

what are rheumatoid factors

autoantibodies that react with immunoglobulin antibodies found in the blood

what is pannus

thickened synovium, a destructive vascular granulation tissue

the inflammatory cells in the pannus prevent the synovium from doing what 2 things?

1) lubricating the joint 2) providing nutrients to the avascular articular cartilage

Changes seen in RA: early stages

swelling of the soft tissue, beginning joint space narrowing, and changes in the metacarpal head can be seen

Changes seen in RA: later stages

In the later stages, the articular space is completely obliterated, and osseous erosions are evident

In RA, cytokines stimulate the secretion of metalloproteinases leading to

articular cartilage destruction synovial hyperplasia local tenderness/swelling/pain

(RA) Elevated cytokines inhibit bone ________ and induce bone _________

bone formation; bone resorption **Cytokines directly and indirectly activate osteoclasts

RA symptoms usually begin ______ and progress _______

insidiously; progress slowly

Pts with RA often initially present with

-fatigue -weight loss -weakness -general, diffuse MSK pain

Deconditioning and depression are common complications of what disease?

RA presents in multiple joints with (asymmetric/symmetric) and (unilateral/bilateral) presentation

symmetric and bilateral

most frequently involved joints of RA

wrist, knee, joints of fingies/hands/foots

Swan neck deformity

hyperextension at the PIP joint

Boutonnière Deformity

flexion at the PIP joint

the longer a person has RA, the greater the likelihood of having what disease?

cervical spine disease

what is a rheumatoid nodule

granulomatous lesions that usually occur in areas of repeated mechanical pressure

Rheumatoid vasculitis involves _______ sized arteries and leads to ________ ________

medium sized arteries; mononeuritis multiplex

small vessel vasculitis causes ________-_______ peripheral neuropathy

stocking-glove

___ is more sensitive than conventional radiography for detecting early signs of RA

MRI

Primary goals in treating RA

-Reduce signs and symptoms to a state of remission -Reduce pain & maintain mobility

Surgeries common for RA

-total joint replacement -synovectomy -tenosynovectomy

synovectomy

primary operation for wrist

tenosynovectomy

most common soft tissue procedure of the hand

mortality in adults with extraarticular manifestations of RA is significantly (lesser/greater) than in adults with RA limited to joints

greater

OA vs RA onset

OA usually begins age 40 RA initially develops between ages 25 and 50

Incidence: OA vs RA

OA: 12% of US adults 60+ RA: 1% of US adults

Gender: OA vs RA

OA: more common in men before age 45; more common in women after age 45 RA: women 3x more than men, more disabling in men

Lab values: OA vs RA

OA: synovial fluid has low WBC and high viscosity RA: synovial fluid has high WBC and low viscosity