Lanigan Osteoarthritis Flashcards

Question

Erosive Osteoarthritis | players

Answer 1

``` Inflammatory cytokines (may be related to obesity): ↑ IL-2, IL-4 receptors, adiponectin; ``` ↓ IL-4, IL-1, TNF-α.

Answer 2

Idiopathic / “wear and tear” OA May be related to aging, obesity, and/or hx of significant but non-injurious joint use May be local (a few joints) or generalized Develops around age 55 ``` Knees - Most common location Hips Hands Spine - Cervical, thoracic, lumbar, spinal canal stenosis Feet - 1st MTP ```

Answer 3

Joint degeneration in a joint with preexisting abnormality. Due to trauma, genetics, inactivity, congenital anomalies, inflammatory/infectious arthritis, hemachromatosis, etc. - Osteoarthritis susceptibility genes: ADAM12, CLIP, COL11A2, IL10, MMP3, MCF2L, others... Develops earlier than primary OA, around age 45.

Answer 4

Osteoarthritis of the elbow is not commonly seen; however, it can occur with a history of previous trauma.

Answer 5

Isolated patellofemoral arthritis may cause anterior knee pain that worsens with climbing stairs or rising from a seated position. As it worsens, it interferes with walking and running. ~5% of pts. with OA of the knee have patellofemoral arthritis without tibiofemoral arthritis. The etiology of knee arthritis is divided equally between patellar dislocation, fracture, and primary osteoarthritis. M (closest distance between articular ridge & medial condyle) L (closest distance between lateral facet & condyle) On exam, compress patella as pt. flexes the knee. Pain is elicited if arthritis is present. Resisted knee extension may also reproduce symptoms.

Answer 6

The degeneration in spine osteoarthritis affects vertebral bodies, neural foramina and facet joints. This is spondylosis (ie, age-related degeneration) & is asymptomatic. In degenerative spondylolisthesis, intersegmental instability is present as a result of spondylosis. The slip occurs from progressive spondylosis within this three-joint motion complex. Most commonly occurs at L4-5 interspace.

Answer 7

``` Education Heat and cold Weight reduction Conditioning Proper footwear / Orthotics Physical Therapy Occupational Therapy Topical Agents - capsaicin, diclofenac ``` ``` Acetaminophen NSAIDs Intra-articular steroids Tramadol Duloxetine (Cymbalta) Viscosupplementation hyaluronic acid (?) Surgery Hydroxychloroquine (esp. in erosive OA) Colchicine ```

Answer 8

> age 70 Neurogenic claudication – worse with prolonged standing or walking, relieved by sitting or lumbar flexion Radicular pain – one or both buttocks or legs

Answer 9

(DISH/Forestier’s disease) M > F. Incidence increases with age. “Flowing osteophytes” in ≥ 4 contiguous vertebrae. (can also see Candle Wax Pattern) Ossification of anterior longitudinal ligament. - Posterior longitudinal ligament occasionally involved. Preservation of joint and disc spaces. No systemic inflammation. Usually asymptomatic. Symptomatic pts. may have pain, stiffness, dysphagia. Associated with Type 2 DM, obesity, hyperuricemia.

Answer 10

It is hypothesized that insulin at prolonged and high physiologic levels promotes new bone growth in the entheseal regions.

Answer 11

differentiation of progenitor cells into osteoblasts, with resultant ossification of ligaments and entheseal areas.

Answer 12

Anterior ligament ossification - may cause dysphagia Rare posterior ligament ossification – potential for cord compression

Answer 13

DISH - clear space between ossified ligament and vertebral body. Ankylosing spondylitis has involvement of SI joints & syndesmophytes. Syndesmophytes bridge across the joint as compared to osteophytes which are non-bridging.

Answer 14

Ligementous Calcification at Entheses are Characteristic of DISH Ligamentous calcification of iliolumbar, sacrotuberous, & acetabular ligaments suggests DISH. Isolated bony spurs in the calcaneum, patella, & olecranon, especially if symmetric, can lead to early diagnosis of DISH. may see whiskering calcifications