MSK II - General Principles of Osteoarthritis

Question 1

causes of arthritis?

Answer 1

DJD, rheumatoid, post-traumatic, post-infection

Question 2

what are modifiable local risk factors for DJD/OA?

Answer 2

muscle strength

physical activity/occupation

joint injury

joint alignment (biggest one)

leg length inequality

Question 3

what muscles are the quad femoris muscles?

Answer 3

vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris

Question 4

quad femoris muscles do what action?

Answer 4

leg extension

Question 5

quads femoris is what primary muscle of the lower limb?

Answer 5

primary antigravity muscle of the lower limb

Question 6

what does quads femoris absorb?

Answer 6

limb loading

Question 7

what does quads femoris provide?

Answer 7

dynamic joint stability

Question 8

improvement in strength of quads femoris is associated with what for knee OA?

Answer 8

associated with reduced pain and improved function in pts with knee OA

Question 9

what muscles should be strengthened for knee OA?

Answer 9

the quads femoris muscles

Question 10

what activities and occupations increase risk of OA?

Answer 10

repetitive joint use

occupations requiring squatting/standing/kneeling - 2x risk of OA

increased manual dexterity - features of hand OA

Question 11

what is one of the most important injuries associated with OA?

Answer 11

ACL rupture

Question 12

when will OA changes been seen in people with joint injury?

Answer 12

within 10 years after initial injury

Question 13

joint injury has risk of OA if accompanied by damage to what?

Answer 13

• Articular cartilage
• Subchondral bone
• Collateral ligaments
• Menisci -> seen in 70% of ACL injured tears

Question 14

what is the HIGHEST modifiable local risk factor for DJD/OA?

Answer 14

joint alignment

Question 15

what is one of the strongest predictors of knee OA progression?

Answer 15

knee malalignment

Question 16

joint alignment is the strongest predictors of what?

Answer 16

OA progression

Question 17

what is malalignment strongly associated with?

Answer 17

increased degradation of compartment under greatest compressive stress

Question 18

medial progression of knee OA 4x more likely in individuals with what?

Answer 18

with varus alignment

Question 19

what is the #1 modifiable systemic risk factor for OA?

Answer 19

obesity

Question 20

obesity is most important risk factor for OA where?

Answer 20

hip/knee OA

Question 21

for every ___ unit increase in BMI, there is a ___ increased risk of knee OA

Answer 21

for every 5 unit increase in BMI, there is a 35% increased risk of knee OA

Question 22

modifiable systemic risk factors for OA?

Answer 22

obesity (#1), diet, bone metabolism

Question 23

what is the #1 predictor of OA?

Answer 23

age

Question 24

non-modifiable systemic risk factors for OA?

Answer 24

age (#1), sex (female), genetics, ethnicity

Question 25

what gender has a higher prevalence and severity of OA?

Answer 25

female

Question 26

if post-menopausal, most likely to have greater x-ray changes where than men?

Answer 26

greater knee x-ray changes

Question 27

what is the first line tx for mild-moderate arthritis pain?

Answer 27

APAP and add topical analgesics PRN

Question 28

if APAP fails or there is inflammation, then what meds for tx?

Answer 28

NSAIDs, viscosupplementation

Question 29

first line tx for arthritis? dose?

Answer 29

APAP - 325-650 mg q5h on scheduled basis

Question 30

max dose of APAP/day if EtOH or liver disease?

Answer 30

2g/day

Question 31

when do you use NSAIDs for arthritis tx?

Answer 31

if APAP fails

Question 32

most common adr of NSAIDs?

Answer 32

GI complaints

Question 33

what is capsaicin? how long to work? used how often?

Answer 33

topical analgesic -extract of hot peppers, beneficial when topically applied over joints 2 weeks to work can use QID, but only BID necessary

Question 34

what meds have a minimal role in DJD?

Answer 34

narcotics

Question 35

when do you use narcotics in DJD?

Answer 35

short term use for exacerbations; post-op

Question 36

when do you NOT use narcotics?

Answer 36

Pre-op

Question 37

valgus braces do what for arthritis?

Answer 37

mediate pain by mechanically stabilizing joint and reducing muscle co-contractions and joint compression

Question 38

poor knee stability correlated with what?

Answer 38

decreased ADLs, quality of life

Question 39

what is an example of viscosupplementation? found where? function?

Answer 39

hyaluronic acid -found in synovial fluid and cartilage function: lubricant and shock absorber has anti-inflammatory effect and antioxidant effect

Question 40

what is definite tx of arthritis?

Answer 40

surgery - arthroplasty or osteotomy

Question 41

risk factor modification for arthritis tx?

Answer 41

muscle strengthening weight management