Mehlman/UW Osteoarthritis 03-07 (3) Flashcards
M. OA = degenerative joint disease.
It is NON-inflammatory disease
M. OA. synovial fluid?
Since it is non-inflammatory -> synovial fluid same
low WBC in synovial. in serum low ESR.
M. what joints?
Hip, knee, hand findings - distal interphalangeal joints, 1st carpometacarpal joint
M. how joints look like?
ASYMETRICAL!!! (Asymmetric joint space narrowing)
contrast to RA - usually symetric
M. highest risk factor?
OBESITY
M. 3 scenatio risk factor?
Obesity
Big and tall and young (<50 y/o)
Heavy lifting on legs for years
M. age?
> 40; prevalence incr with age
if big+tall+ young (<50) = despite age
M. HY prevention?
WEIGH LOSS!!!!
M. what is Eburnation?
its a term that refers to the ivory-like appearance of bone in OA at sites of cartilage erosion
UW. morning stiffness?
none or brief < 30 min
UW. Systemic symptoms?
absent
UW. examination?
hard, bony enlargement of joints, reduced ROM
M. Tx? 2
weight loss –> acetaminophen
acet. is correct before nsaids, because its non-inflammatory, therefore nsaid wont do any better
M. what always funckin wrong Tx?
STEROIDS (intra or oral)
M. what other 2 also wrong Tx?
injections of glycosaminoglycans
use of capsaicin cream
M. most viggnettes on nbme: 40-50 yo + high BMI.
.
M. hands DIP?
Heberden nodes
M. hands PIP?
Bouchard nodes
M. RA does not affect DIPs.
If see xray and everything is fucked up –> check if something is wrong with DIP. if yes –> it is not RA, and likely its OA.
.
UW. Tx scheme
weight loss –> acetaminophen –> NSAIDS –> next?
Intraarticular GK
topical capsaicin cream
symptoms persists –> surgery (if possible); chronic pain management
As M said, its always fuckin wrong answers
M. case. Older + OA + takes nsaids + peripheral edema, why?
kidney damage –> answer is decr. sodium secretion/incr. Na retention
UW. synovial effusion in osteoarthritis.
in what patients?
older patients with OA
UW. synovial effusion in osteoarthritis.
Popliteal (Baker) cyst formation?
communication of joint space with gastrocnemius or semimembranous bursa allows the synovial fluid to flow posteriorly into the bursa, forming popliteal cyst (Baker)
UW. secondary osteoarthritis.
causes: prior joint injury/surgery
infection
inflammatory disorders, eg RA
congenital or acquired body deformities
neuromuscular weakness
hemochromatosis
.
UW. synovial effusion in osteoarthritis.
Osteoarthritis develops within 10 years in most patients with anterior cruciate ligament injury, and the risk is increased regardless of whether the tear is surgically required.
.
UW. OA table. Joint involvement?
knees
hips
distal interphalangeal joints
1st carpometacarpal joint
UW. hip arthritis CP?
pain in groin, buttock, lateral hip AND can radiate to the lower tight or knee.
UW table. risk factors for OA. Modifiable 4?
Sedentary lifestyle
Obesity (MCC)
Occupational joint loading
DM
UW table. risk factors for OA. Nonmodifiable 5?
Advanced age
female sex
family history
abnormal joint alignment
prior joint trauma
UW Q. examination findings suggesting OA?5
Periarticular bony hypertrophy and tenderness
Limited range of motion with crepitus and pain
Small joint effusion without erythema or warmth
Varus or valgus angulation
Popliteal (Baker) cyst behind the joint
UW table. hand OA. Initial management? 2
Stretching and strengthening exercises
topical or oral nsaids
topical usually sufficient
oral carries a risk for peptic ulcer disease
