MSK II - General Principles of Osteoarthritis Flashcards
causes of arthritis?
DJD, rheumatoid, post-traumatic, post-infection
what are modifiable local risk factors for DJD/OA?
muscle strength
physical activity/occupation
joint injury
joint alignment (biggest one)
leg length inequality
what muscles are the quad femoris muscles?
vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris
quad femoris muscles do what action?
leg extension
quads femoris is what primary muscle of the lower limb?
primary antigravity muscle of the lower limb
what does quads femoris absorb?
limb loading
what does quads femoris provide?
dynamic joint stability
improvement in strength of quads femoris is associated with what for knee OA?
associated with reduced pain and improved function in pts with knee OA
what muscles should be strengthened for knee OA?
the quads femoris muscles
what activities and occupations increase risk of OA?
repetitive joint use
occupations requiring squatting/standing/kneeling - 2x risk of OA
increased manual dexterity - features of hand OA
what is one of the most important injuries associated with OA?
ACL rupture
when will OA changes been seen in people with joint injury?
within 10 years after initial injury
joint injury has risk of OA if accompanied by damage to what?
- Articular cartilage
- Subchondral bone
- Collateral ligaments
- Menisci -> seen in 70% of ACL injured tears
what is the HIGHEST modifiable local risk factor for DJD/OA?
joint alignment
what is one of the strongest predictors of knee OA progression?
knee malalignment
joint alignment is the strongest predictors of what?
OA progression
what is malalignment strongly associated with?
increased degradation of compartment under greatest compressive stress
medial progression of knee OA 4x more likely in individuals with what?
with varus alignment
what is the #1 modifiable systemic risk factor for OA?
obesity
obesity is most important risk factor for OA where?
hip/knee OA
for every ___ unit increase in BMI, there is a ___ increased risk of knee OA
for every 5 unit increase in BMI, there is a 35% increased risk of knee OA
modifiable systemic risk factors for OA?
obesity (#1), diet, bone metabolism
what is the #1 predictor of OA?
age
non-modifiable systemic risk factors for OA?
age (#1), sex (female), genetics, ethnicity
what gender has a higher prevalence and severity of OA?
female
if post-menopausal, most likely to have greater x-ray changes where than men?
greater knee x-ray changes
what is the first line tx for mild-moderate arthritis pain?
APAP and add topical analgesics PRN
if APAP fails or there is inflammation, then what meds for tx?
NSAIDs, viscosupplementation
first line tx for arthritis? dose?
APAP - 325-650 mg q5h on scheduled basis
max dose of APAP/day if EtOH or liver disease?
2g/day
when do you use NSAIDs for arthritis tx?
if APAP fails
most common adr of NSAIDs?
GI complaints
what is capsaicin? how long to work? used how often?
topical analgesic
-extract of hot peppers, beneficial when topically applied over joints
2 weeks to work
can use QID, but only BID necessary
what meds have a minimal role in DJD?
narcotics
when do you use narcotics in DJD?
short term use for exacerbations; post-op
when do you NOT use narcotics?
Pre-op
valgus braces do what for arthritis?
mediate pain by mechanically stabilizing joint and reducing muscle co-contractions and joint compression
poor knee stability correlated with what?
decreased ADLs, quality of life
what is an example of viscosupplementation? found where? function?
hyaluronic acid
-found in synovial fluid and cartilage
function: lubricant and shock absorber
has anti-inflammatory effect and antioxidant effect
what is definite tx of arthritis?
surgery - arthroplasty or osteotomy
risk factor modification for arthritis tx?
muscle strengthening
weight management
